Healing the Invisible Wounds: Understanding and Treating PTSD Among Military Veterans
Post-traumatic stress disorder (PTSD) has become one of the most pressing mental health issues among military veterans, particularly in the wake of modern conflicts in Iraq and Afghanistan. Years of exposure to intense combat, guerrilla warfare, and constant danger have left many veterans struggling with lasting psychological trauma. Despite increased public awareness and advances in treatment, PTSD continues to impose severe emotional, social, and economic burdens, both on individuals and on the healthcare system (Reisman, 2016).
PTSD among veterans is not a new phenomenon – it is a modern understanding of a condition that has existed as long as warfare itself. Historical records describe symptoms akin to PTSD as far back as ancient Greece, and over the centuries it has been labeled by many names, from “shell shock” during World War I to “battle fatigue” in World War II. The diagnosis of PTSD became formalized only in 1980, after the Vietnam War made clear the long-term psychological cost of combat. Contemporary studies estimate that between 13% and 30% of Iraq and Afghanistan veterans have experienced PTSD, with as many as half a million diagnosed cases over the past two decades (Reisman, 2016).
The condition rarely exists in isolation. Many veterans with PTSD also suffer from depression, anxiety, substance use disorders, and chronic pain, which together complicate both diagnosis and treatment. Depression is the most common comorbidity, and substance use is widespread among those attempting to cope with symptoms of trauma. Such overlapping conditions lead to higher rates of suicide, social isolation, and medical complications, making recovery a complex process requiring integrated care. Women veterans are particularly vulnerable, not only because of combat exposure but also due to the high prevalence of military sexual trauma, which can heighten the risk of developing PTSD (Reisman, 2016).
Diagnosis of PTSD involves both clinical interviews and self-report tools. Instruments such as the Clinician-Administered PTSD Scale (CAPS-5) and the PTSD Checklist (PCL-5) help determine symptom severity and functional impairment. The DSM-5 defines PTSD through four main symptom clusters—intrusion, avoidance, negative mood and cognition, and arousal—which reflect the range of ways trauma manifests in the mind and body. These diagnostic criteria guide clinicians toward evidence-based treatment approaches.
Cognitive-behavioral therapy (CBT) remains the most effective psychological treatment for PTSD. In particular, cognitive processing therapy (CPT) and prolonged exposure (PE) therapy are strongly supported by clinical evidence and widely used in veteran care. CPT focuses on identifying and restructuring distorted thoughts about the traumatic event, while PE encourages controlled and repeated engagement with trauma memories to reduce fear responses. Another therapy, eye-movement desensitization and reprocessing (EMDR), once met with skepticism, is now recognized internationally as an effective intervention that helps patients process trauma through guided eye movements and attention refocusing (Reisman, 2016).
While psychotherapy is the preferred first-line approach, pharmacological treatments are also important, particularly for those who do not respond fully to therapy. Selective serotonin reuptake inhibitors (SSRIs) such as sertraline and paroxetine are the only FDA-approved drugs for PTSD, although others like fluoxetine and venlafaxine are used off-label. These medications help regulate mood and anxiety symptoms but rarely lead to full remission. Researchers are increasingly investigating alternative pharmacological pathways, such as those involving GABA and glutamate neurotransmission. New drugs like vortioxetine, vilazodone, and even certain anticonvulsants such as topiramate are under study for their potential to modulate fear and memory processes. Some veterans also report relief from cannabis use, though its medical application remains controversial and tightly regulated (Reisman, 2016).
Combined treatment approaches – using both medication and psychotherapy – are often the most effective, particularly for veterans with severe or treatment-resistant PTSD. However, benzodiazepines, once commonly prescribed to manage anxiety, are now discouraged due to their limited efficacy and potential for dependency. The Veterans Affairs (VA) system has begun implementing education and shared decision-making programs to reduce benzodiazepine use and encourage evidence-based alternatives.
Beyond treatment, systemic and social barriers continue to hinder recovery. Many veterans face long wait times at VA facilities, limited access to mental health providers- especially in rural areas – and the persistent stigma associated with seeking psychological help. Cultural attitudes within the military often equate mental illness with weakness, deterring individuals from pursuing care. The VA has responded through public awareness campaigns like “About Face,” which normalizes PTSD treatment, and through telehealth services that provide remote therapy options. Studies indicate that telemedicine not only increases accessibility but also improves engagement and treatment adherence among veterans living far from urban centers (Reisman, 2016).
As more veterans seek care outside the VA system, the preparedness of community-based mental health providers has become a growing concern. Many civilian clinicians lack the training to address combat-related trauma effectively. To bridge this gap, the VA established the PTSD Consultation Program for Community Providers and partnered with organizations such as the Center for Deployment Psychology and Star Behavioral Health Providers, which train professionals in veteran-specific mental health care.
Despite ongoing research and program development, PTSD remains one of the most significant public health challenges facing veterans. Its economic cost exceeds billions of dollars annually, and its human cost is measured in the thousands of suicides that occur each year among former service members. Continued investment in both psychological and pharmacological research, alongside improved access to culturally competent care, is essential. Addressing PTSD requires not only medical intervention but also systemic reform and societal understanding to ensure that those who have endured the traumas of war receive the comprehensive care and dignity they deserve (Reisman, 2016).
Anxious Attachment and the Psychology of People-Pleasing
Attachment theory provides one of the most insightful frameworks for understanding how individuals form, maintain, and sometimes sabotage their relationships. Developed by John Bowlby and later refined by Mary Ainsworth, attachment theory proposes that early interactions with caregivers shape internal models of security and trust that influence later relationships. Among the attachment patterns identified – secure, avoidant, and anxious – the anxious attachment style stands out as particularly associated with emotional dependency, fear of abandonment, and maladaptive interpersonal behaviors such as people-pleasing. People-pleasing can be seen as a behavioral manifestation of the anxious attachment system, a desperate attempt to maintain proximity and approval from significant others by sacrificing one’s own needs and autonomy. Although such behaviors may temporarily stabilize relationships, they tend to perpetuate insecurity, dissatisfaction, and emotional exhaustion. Understanding how anxious attachment leads to people-pleasing not only clarifies the roots of this behavior but also illuminates potential paths toward healthier relational dynamics.
Bowlby’s conceptualization of attachment as an innate survival mechanism underscores the human need for closeness and protection. In infancy, this attachment is primarily directed toward the caregiver, whose responsiveness determines the child’s sense of safety. Infants who experience consistent care develop secure attachments, internalizing the belief that others are reliable and that they themselves are worthy of love. Conversely, when caregivers are inconsistent – alternating between attentiveness and unresponsiveness—children may develop anxious attachment. They learn that love and care are unpredictable, fostering hypervigilance and a chronic fear of rejection. These early experiences become mental templates that persist into adulthood, shaping expectations and behaviors in close relationships. Adults with an anxious attachment style often seek excessive reassurance, interpret neutral cues as signs of disinterest, and overinvest emotionally in relationships to avoid perceived abandonment.
Empirical research has consistently demonstrated that early attachment patterns predict later relational outcomes. Securely attached adults tend to experience higher satisfaction, stability, and mutuality in their friendships and romantic partnerships. They are comfortable with intimacy and capable of managing separation without significant distress. In contrast, those with insecure attachment, particularly the anxious subtype, often report greater conflict, dependency, and ambivalence in their relationships. Studies have shown that anxious individuals display heightened physiological responses to perceived rejection and are prone to rumination about their partners’ availability. Their preoccupation with maintaining closeness can result in behavioral patterns that, paradoxically, undermine the very security they crave. One of the most common of these behaviors is people-pleasing – the excessive prioritization of others’ needs and desires at the expense of one’s own.
People-pleasing, as a psychological construct, refers to a pervasive tendency to seek approval, avoid conflict, and gain affection through compliance and self-sacrifice. It is not simply politeness or altruism; rather, it involves an underlying fear that rejection or disapproval will result in the loss of the relationship. Anxiously attached individuals are particularly vulnerable to this dynamic. Because they equate love with acceptance and attention, they may adopt submissive or accommodating behaviors as strategies to secure attachment. They may agree to requests they find uncomfortable, suppress their opinions to avoid disapproval, or apologize excessively even when not at fault. On the surface, these behaviors appear prosocial – people-pleasers are often described as kind, helpful, and empathetic. However, beneath this facade lies anxiety, low self-worth, and an inability to assert personal boundaries.
The relationship between anxious attachment and people-pleasing can be better understood through the lens of emotion regulation. When anxiously attached individuals perceive potential threats to their relationship – such as conflict, criticism, or distance – they experience intense emotional distress. To alleviate this discomfort, they engage in what attachment theorists call “hyperactivating strategies.” These include excessive reassurance-seeking, clinging, and compliance – behaviors designed to elicit closeness or validation from the attachment figure. People-pleasing functions as one of these strategies: by accommodating others’ needs and suppressing one’s own, the individual temporarily reduces anxiety about abandonment. Yet, over time, these patterns reinforce dependency and prevent the development of authentic, reciprocal intimacy.
Neuroscientific research provides further evidence for this dynamic. Studies have found that individuals with an anxious attachment style exhibit heightened activation in brain regions associated with social pain and rejection, including the amygdala, dorsal anterior cingulate cortex, and anterior insula. This suggests that anxiously attached people literally experience social rejection as a threat to survival. Consequently, their efforts to prevent such rejection become compulsive and self-defeating. People-pleasing, in this sense, represents an attempt to regulate a hyperactive attachment system by ensuring relational security through constant appeasement. Unfortunately, this strategy often leads to resentment, burnout, and the perpetuation of insecure bonds.
Two major forms of people-pleasing behaviors can be distinguished in this context: harmful self-sacrifice and risky conformity. Harmful self-sacrifice involves consistently neglecting personal needs, values, or boundaries in order to satisfy others. An anxiously attached person may, for example, take on unreasonable tasks for a friend or partner, suppress emotional needs, or avoid expressing disagreement to maintain harmony. While self-sacrifice can be an expression of love when balanced and mutual, in the case of anxious attachment it often stems from fear rather than genuine care. Partners or friends may eventually perceive such constant giving as excessive or inauthentic, which can strain the relationship rather than strengthen it. Research indicates that individuals who engage in self-sacrificial behaviors out of fear of rejection report lower relationship satisfaction and greater emotional exhaustion.
Risky conformity, another manifestation of people-pleasing, refers to the tendency to adopt others’ behaviors or opinions – sometimes even engaging in harmful activities—to avoid rejection. Adolescents and young adults with anxious attachment, for instance, have been found more likely to conform to peers’ risky behaviors such as substance use or unsafe social practices. This is not due to impulsivity but rather to an overreliance on external validation. By mirroring others’ actions, anxiously attached individuals hope to maintain acceptance within the group. However, this conformity further erodes their sense of self, reinforcing the belief that approval must be earned through compliance rather than authenticity.
Over time, people-pleasing becomes part of a destructive cycle. The more an individual sacrifices their needs for others, the less confident they feel in their own worth. This diminished self-esteem, in turn, increases their dependence on external approval, perpetuating anxious attachment dynamics. Each act of self-denial or forced conformity strengthens the internal narrative of unworthiness and fear of abandonment. The result is a paradoxical relationship pattern: the very behaviors intended to preserve closeness ultimately generate distance, frustration, and instability. The partner or friend may grow weary of constant reassurance demands, while the anxious individual feels even more insecure, interpreting any withdrawal as confirmation of their fears.
Breaking this cycle requires both cognitive and behavioral change. Anxiously attached individuals can begin by cultivating a sense of internal security independent of external validation. One effective approach is the practice of emotional detachment – not in the sense of indifference, but as a balanced ability to be alone without distress. Learning to tolerate separation and uncertainty helps recalibrate the attachment system, reducing the compulsion to please others. Research suggests that when anxiously attached individuals believe that they will find new, supportive relationships, they are more capable of letting go of unhealthy ones. This cognitive reframing – recognizing that one’s worth and security do not depend on a single person – fosters resilience and reduces people-pleasing tendencies.
Another key step involves shifting perspective on social cues and perceived threats. Because anxious individuals tend to interpret neutral behaviors as signs of rejection, learning to reinterpret these cues can reduce unnecessary anxiety. Cognitive-behavioral strategies, such as identifying and challenging automatic negative thoughts, can help them recognize that not every delayed text or ambiguous remark indicates disapproval. Emotional regulation skills, such as mindfulness and grounding exercises, further assist in moderating hyperactive responses. By viewing others’ behaviors more objectively, anxiously attached individuals can respond with authenticity rather than compliance.
Open communication also plays a crucial role. People-pleasers often avoid expressing negative emotions or needs, fearing that honesty will lead to rejection. However, research demonstrates that constructive communication strengthens, rather than threatens, relationships. When anxiously attached individuals learn to express their needs clearly and respectfully, they invite reciprocity and reduce misunderstandings. This process requires courage and practice, as it contradicts the ingrained belief that love must be earned through self-denial. Over time, honest dialogue can transform relationships from asymmetrical dependence to mutual respect.
Equally important is the skill of assertive refusal. People-pleasers must learn to differentiate between kindness and compliance, understanding that saying “no” does not equate to rejection or selfishness. Setting boundaries is not only protective but also a sign of self-respect, signaling to others that their needs and comfort matter. Assertiveness training can help anxiously attached individuals develop this capacity, teaching them to decline requests without guilt or hostility. Small acts of refusal – such as declining an unreasonable favor or expressing disagreement – can gradually rewire the association between self-assertion and fear of abandonment. As individuals learn that healthy relationships withstand boundaries, their internal security strengthens.
Ultimately, the path from people-pleasing to secure relating involves cultivating self-compassion. Anxiously attached individuals often internalize shame about their dependency and emotional sensitivity. Recognizing that these tendencies arise from unmet childhood needs rather than personal weakness can be liberating. Self-compassion allows individuals to respond to their fears with understanding rather than criticism, creating the emotional safety necessary for change. Therapeutic interventions that emphasize self-acceptance, such as attachment-based therapy or mindfulness practices, have been shown to reduce attachment anxiety and foster healthier relational patterns.
In conclusion, the link between anxious attachment and people-pleasing illustrates how early experiences of inconsistency and insecurity shape lifelong relational strategies. People-pleasing emerges as an attempt to mitigate the pain of potential rejection by ensuring approval through compliance and self-sacrifice. Yet, these behaviors paradoxically deepen insecurity, undermine satisfaction, and perpetuate fragile relationships. By practicing detachment, reinterpreting social cues, communicating openly, and setting boundaries, anxiously attached individuals can begin to dismantle the cycle of people-pleasing and move toward genuine intimacy. Future research should continue to explore how attachment-based interventions can reduce people-pleasing behaviors across different cultural and gender contexts. Ultimately, healing anxious attachment is not about eliminating the desire for closeness but about learning to pursue connection from a place of confidence rather than fear – a transformation that replaces the compulsion to please with the capacity to love authentically.
How to Stop Being a People-Pleaser
Being a people-pleaser often begins as a desire to help, to be seen as kind, dependable, and cooperative. Yet this desire can slowly transform into a trap—one that ties self-worth to the approval of others. In the workplace, the people-pleaser is the person who cannot say no, who always volunteers for extra work, and who measures their value by how useful they are to the group. Despite their efforts, they are rarely appreciated, often becoming invisible or taken for granted.
The roots of this behavior usually reach back to childhood. From an early age, children learn that being “good” or “bad” depends on the emotional reactions of the adults around them. When being helpful and compliant earns affection and attention, that pattern becomes deeply ingrained. As adults, these early lessons evolve into a belief that one’s worth is defined by how much others approve or need them. The result is an endless cycle of seeking validation through service, at the cost of personal boundaries and emotional balance.
Breaking free from this pattern requires confronting the anxiety that drives it. For many, the thought of not pleasing others provokes deep discomfort—if they are not the helpful one, will they still matter? Learning to put oneself first begins by questioning motives: “Why am I doing this?” and “Who is this really for?” There is nothing wrong with being kind or cooperative, but when those actions come from fear of rejection rather than genuine choice, they stop being healthy.
Learning to say no is a vital skill. Practicing refusal, even in imagined situations, helps reveal the emotions that surface—guilt, shame, or fear of disapproval. Instead of burying those feelings, sitting with them allows understanding and growth. Each time a person resists the automatic “yes,” they reclaim a small part of their independence. Over time, the discomfort fades and is replaced by a sense of control and self-respect.
Another important realization is that self-worth is not dependent on how others see us. It is natural for relationships to involve mixed emotions—others will not always feel positively toward us, just as we cannot always be pleased with them. Accepting this ambivalence is part of emotional maturity. Likewise, understanding that disappointment is inevitable in human relationships allows us to connect more authentically. To never disappoint or be disappointed is to live without real connection or honesty.
The fantasy of the perfect workplace—where everyone is kind, cheerful, and endlessly supportive—does not exist. Real workplaces, like real families, are filled with differing moods, frustrations, and imperfections. Constantly striving to maintain harmony through self-sacrifice drains energy and erodes confidence. True teamwork does not come from pleasing everyone but from being honest, setting limits, and respecting both personal and collective boundaries.
Ultimately, the path away from people-pleasing is not about becoming unkind or unhelpful. It is about reclaiming the right to make choices that honor one’s own needs as much as others’. Saying no does not mean being selfish; it means recognizing that kindness has no value when it is forced or fearful. By letting go of the compulsion to please, a person creates space for authenticity, confidence, and genuine respect—both from themselves and from those around them.
How to Talk to ANYONE
Medical Cannabis in the United Kingdom: From Principle to Practice
The introduction of medical cannabis in the United Kingdom in November 2018 marked a significant milestone in the long and contentious history of cannabis policy. After decades of prohibition, cannabis was reclassified to allow its use for medicinal purposes, creating widespread public optimism that patients would finally gain access to this long-debated therapy. However, two years after legalization, the reality fell far short of expectations. Despite growing evidence of therapeutic potential and high public demand, only a handful of prescriptions had been issued by the National Health Service (NHS), leaving patients frustrated and many forced to seek cannabis from illicit sources. The article “Medical Cannabis in the UK: From Principle to Practice” by Schlag et al. (2020) explores this disparity between principle and practice, analysing the scientific evidence, ethical challenges, regulatory barriers, and potential future directions for medical cannabis in the UK. This essay critically examines these dimensions, highlighting the tension between patient need, scientific uncertainty, and institutional caution that continues to shape the medical cannabis debate.
At the heart of the issue lies the historical and political trajectory of cannabis itself. Once regarded as one of the world’s oldest medicines, cannabis was criminalised in the mid-twentieth century largely for political reasons rather than empirical evidence of harm. Its reintroduction as a medicinal substance, therefore, represents a partial correction of that political error. Yet, as Schlag et al. observe, the move from prohibition to prescription has been hampered by a lack of clinical evidence stemming from its former classification as a Schedule 1 drug. The National Institute for Health and Care Excellence (NICE) guidelines currently sanction only three cannabis-based medicinal products (CBMPs): Sativex for multiple sclerosis spasticity, Nabilone for chemotherapy-induced nausea and vomiting, and Epidyolex for severe, treatment-resistant epilepsy. For patients suffering from chronic pain, anxiety, or other debilitating conditions, this narrow scope of approved treatments is profoundly disappointing, especially when many report significant benefits from unlicensed or illicit cannabis use. The mismatch between clinical caution and patient experience reveals a deeper tension between traditional evidence-based medicine and the growing field of patient-reported outcomes.
Scientific research on medical cannabis remains in an early stage. The 2017 report by the National Academies of Sciences, Engineering, and Medicine (NASEM) summarised that substantial evidence supports cannabis’s efficacy in treating chronic pain, chemotherapy-induced nausea, and multiple sclerosis spasticity. Moderate evidence exists for improving sleep outcomes, while only limited evidence supports its use for conditions like anxiety, Tourette’s syndrome, or post-traumatic stress disorder. Schlag et al. highlight that the lack of large-scale randomised controlled trials (RCTs) has constrained acceptance by regulators and physicians alike. Yet, the absence of such data is itself a consequence of cannabis’s legal status, which for decades restricted research access. The authors argue that while RCTs remain the gold standard for clinical evidence, other forms of evidence — such as observational studies and patient-reported data — must also be valued. Indeed, real-world evidence from countries such as Canada and Germany demonstrates widespread patient satisfaction and quality-of-life improvements associated with medical cannabis. Studies have reported reductions in pain, anxiety, and opioid use, suggesting that cannabis may offer a safer alternative or adjunct to existing therapies. However, these findings remain controversial, as critics question the reliability of self-reported outcomes and warn against overgeneralisation.
Despite growing international support for medical cannabis, the UK faces unique barriers to implementation. One of the most prominent issues is the lack of physician education. Most British doctors have received no formal training in prescribing cannabis-based medicines, leading to uncertainty about dosages, formulations, and potential interactions. Schlag et al. cite initiatives such as the Academy of Medical Cannabis and Drug Science’s MyMedic platform as important steps toward filling this knowledge gap. Nevertheless, the inertia within medical education remains a key bottleneck. The reluctance of doctors is compounded by restrictive clinical guidelines that position cannabis as a last-resort treatment, permissible only when conventional medicines have failed. These guidelines, produced by authoritative bodies such as the Royal College of Physicians and the British Paediatric Neurology Association, create an environment of medical conservatism that discourages experimentation and innovation.
Another significant obstacle is the fear of adverse psychological effects, particularly psychosis and dependency. Public discourse around cannabis has long been dominated by the association between high-potency cannabis and mental illness, largely based on studies of recreational use. However, Schlag et al. argue that these concerns are often exaggerated or misapplied to medical contexts. The psychosis risk is primarily linked to high-THC, low-CBD street cannabis, whereas regulated medical formulations contain balanced cannabinoid profiles designed to mitigate such risks. Furthermore, data from Health Canada and other countries indicate a low incidence of dependence among medical users. Nonetheless, the perception of cannabis as a dangerous drug continues to influence prescribing behaviour, creating an implicit bias against its medical application. Overcoming this stigma requires not only education but also robust regulatory oversight to ensure product safety, dosage consistency, and responsible use.
Economic factors further complicate access. Because most NHS doctors refuse to prescribe cannabis, patients must rely on private clinics, where treatment can cost up to £40,000 per year. These prohibitive expenses reflect both import restrictions and the lack of domestic production infrastructure. Until recently, UK regulations required individual import licenses for each patient, causing delays and increasing costs. Although new provisions for bulk importation were introduced in 2020, the system remains inefficient compared to other European countries such as the Netherlands or Germany. Schlag et al. suggest that the high cost of medical cannabis is paradoxical, given that it has the potential to reduce healthcare expenditure by lowering reliance on opioids, benzodiazepines, and other costly medications. A comprehensive cost-benefit analysis might reveal that broader access to cannabis could be not only therapeutically beneficial but also economically rational.
Beyond logistical and economic barriers, the article raises fundamental ethical questions. The authors emphasise that the rigid insistence on RCT evidence as the sole criterion for legitimacy may inadvertently harm patients who have exhausted conventional treatments. In such cases, patient autonomy and the principle of informed choice become ethically significant. Denying access to potentially beneficial treatments due to bureaucratic inertia or evidentiary conservatism can be viewed as a moral failure of the healthcare system. Schlag et al. argue that while clinicians must act cautiously, they also have an ethical duty to balance potential harms against the immediate suffering of patients. The reclassification of cannabis as a Schedule 2 substance implies legal recognition of its medical potential; therefore, withholding it on procedural grounds risks undermining public trust in the healthcare system. Moreover, when patients turn to illicit markets due to lack of access, they expose themselves to unregulated and potentially harmful products, highlighting the urgent need for a controlled but compassionate prescribing framework.
The authors propose several strategies for reconciling these competing imperatives. Education and monitoring are at the forefront of their recommendations. By collecting systematic data on prescriptions, patient outcomes, and adverse effects, regulators can bridge the gap between clinical trials and real-world practice. Initiatives such as Drug Science’s Project Twenty21 aim to create Europe’s largest medical cannabis registry, offering valuable insights into usage patterns and efficacy. Such registries could serve as dynamic feedback systems, allowing doctors to make evidence-informed decisions even in the absence of traditional RCTs. Schlag et al. also advocate for developing a hierarchy of evidence specific to cannabis-based medicines, recognising that their diversity of formulations and effects defies simple categorisation. The authors note that cannabis should not be treated as a single drug but rather as a family of compounds with complex pharmacological interactions, requiring a more nuanced approach to research and policy.
Communication with the public is another crucial component. The 2018 rescheduling generated widespread misunderstanding, with many patients assuming that cannabis would become readily available through the NHS. The resulting disappointment has eroded confidence in both the government and the medical establishment. Schlag et al. call for clearer, more transparent communication strategies that explain what medical cannabis can and cannot do. Overhyping its benefits risks creating false hope, while excessive caution perpetuates stigma and frustration. An informed public dialogue, grounded in scientific honesty and empathy for patient experience, is essential for building a sustainable framework.
In conclusion, Schlag et al.’s analysis reveals that the legalisation of medical cannabis in the UK has so far been more symbolic than substantive. While the rescheduling from Schedule 1 to Schedule 2 was a necessary first step, systemic barriers have prevented meaningful patient access. The article makes a compelling case for reform on multiple fronts: expanding the evidence base beyond RCTs, improving physician education, reducing economic barriers, and developing ethical and regulatory frameworks that prioritise patient welfare. The central message is that progress requires balance — between caution and compassion, between evidence and experience, between science and social justice. Cannabis is not a miracle cure, but neither should it be dismissed as a dangerous relic of counterculture. As the authors conclude, medical cannabis policy must evolve in a safe, ethical, and evidence-informed manner, ensuring that those who could genuinely benefit are no longer left behind. The challenge for the UK is not whether to allow medical cannabis, but how to implement it responsibly — transforming principle into practice and rhetoric into care.
The World’s Leading Autism Expert – Professor Sir Simon Baron-Cohen
Understanding How and Why People Stop Offending: Insights from Desistance Research
Desistance—the process by which individuals cease offending – is a critical yet complex area of study in criminology and criminal justice. Research led by Fergus McNeill, Stephen Farrall, Claire Lightowler, and Shadd Maruna highlights that desistance is not simply a function of aging or external control, but a multifaceted process influenced by personal, social, and structural factors. Understanding how and why people stop offending has profound implications for improving criminal justice practices, policies, and the broader social environment in which individuals attempt to change their lives.
Historically, explanations for desistance often focused on biological or maturational factors. Early theorists, such as Goring in 1919 and the Gluecks in the 1930s, suggested that aging itself naturally led individuals to desist from crime. While age remains a strong predictor of reduced offending, contemporary research recognizes that age alone cannot explain why people stop engaging in criminal behavior. The effects of aging are mediated by life experiences, social transitions, and personal decisions, making the process of desistance far more nuanced than early biological models suggested.
Subsequent research emphasized the role of individual choice and volition. Studies in the 1980s and 1990s found that many former offenders attributed their decision to stop offending to personal experiences such as shocks or setbacks, growing weary of incarceration, or reassessing their life priorities. While these decisions alone are insufficient to guarantee desistance, they are often a necessary first step, reflecting a readiness to engage in meaningful change. This perspective was complemented by theoretical models, such as Moffitt’s taxonomy of offenders, which distinguished between adolescence-limited and life-course persistent offenders, highlighting how developmental pathways intersect with the likelihood of desisting.
Beyond individual decision-making, the social context of desistance has emerged as a crucial factor. Sampson and Laub’s influential work emphasizes the importance of social bonds to family, employment, marriage, and community institutions. Strong, positive relationships often provide the emotional support, resources, and sense of purpose necessary to sustain change. Conversely, weak or broken social ties can increase the risk of continued offending. More recently, scholars such as Maruna have emphasized the role of self-identity in the desistance process. Developing a coherent, pro-social identity allows former offenders to reinterpret past experiences and view themselves as capable of leading meaningful lives. For many, desistance involves finding ways to use their past experiences constructively, such as mentoring others or contributing to their communities.
Theories of cognitive transformation, such as those proposed by Giordano and colleagues, describe desistance as a process that combines individual agency with social opportunity. It begins with a willingness to change, exposure to turning points or “hooks for change,” the ability to envision a positive alternative identity, and ultimately, a reconceptualization of past deviant behavior as irrelevant or undesirable. These insights underscore that desistance is both a deeply personal journey and a socially mediated process, shaped by the interactions between the individual and their environment.
The implications of desistance research for criminal justice practice are profound. Effective probation and social work supervision must recognize that desistance is complex, subjective, and often non-linear. Supporting change requires building hope and motivation, respecting agency, identifying and nurturing strengths, and facilitating access to opportunities for positive social roles. Supervision that simply enforces compliance or focuses narrowly on risks and deficits is unlikely to foster long-term change. Instead, interventions should work collaboratively with individuals, supporting their aspirations while providing practical assistance with housing, employment, education, and relationships.
Desistance research also has broader implications for the design of criminal justice systems. Innovative approaches to sentencing, such as problem-solving courts or restorative payback schemes, draw on the evidence that engagement, choice, and constructive participation can enhance the likelihood of desistance. Prison systems, too, can play a role in fostering change when they focus on meaningful relationships, skill development, and the cultivation of non-criminal identities, rather than simply containment. However, as the evidence emphasizes, prisons alone cannot secure desistance; reintegration into families, communities, civil society, and the wider social fabric is essential. Countries such as Norway have institutionalized this perspective through legally enforceable reintegration guarantees, highlighting the importance of collective responsibility in supporting ex-offenders.
Ultimately, desistance is not simply a matter of “correcting” the individual; it is a social and moral process that involves repairing relationships, rebuilding trust, and enabling individuals to reclaim meaningful roles in society. By focusing on positive change, development, and potential, desistance research challenges the criminal justice system to move beyond punitive paradigms and toward practices that genuinely support rehabilitation and reintegration. The study of how and why people stop offending offers a roadmap for policies, interventions, and institutions that recognize human capacity for change and the essential social dimensions of transformation.
The Good Lives Model: A Strengths-Based Approach to Rehabilitation
The Good Lives Model (GLM) represents a positive and strengths-based approach to offender rehabilitation. Developed by Tony Ward in 2010, it focuses on promoting personal fulfilment, well-being, and the pursuit of meaningful life goals rather than solely addressing risk factors or deficits. While it differs in emphasis from the traditional Risk-Need-Responsivity (RNR) framework, the GLM complements risk management by providing a more holistic, person-centred and engaging structure for rehabilitation (Ward & Fortune, 2013).
At the core of the GLM lies the belief that all individuals strive to achieve certain “primary human goods.” These are fundamental needs and aspirations that contribute to psychological well-being, such as life, knowledge, creativity, pleasure, spirituality, friendship, community, inner peace, excellence in work and play, and excellence in agency or autonomy. People pursue these goods through “secondary goods,” which are the specific activities or means used to achieve them. For example, running might be a secondary good that satisfies the primary good of excellence in play. However, when individuals lack the internal skills or external resources to pursue these goods in healthy and pro-social ways, they may resort to harmful or illegal behaviours. A person might, for instance, engage in harmful sexual behaviour as a misguided attempt to meet needs for intimacy or inner peace (Willis, Yates, Gannon & Ward, 2012).
The GLM views intervention as a process that helps individuals build the skills, strengths, and supports necessary to pursue their goals without harming others. Practitioners work collaboratively with clients to explore their values, aspirations, and personal definitions of a “good life.” Together, they develop a Good Lives Plan, identifying alternative and socially acceptable ways to meet primary goods while addressing risk factors that could hinder success (Purvis, Ward & Willis, 2011). This approach aims to replace harmful behaviours with positive strategies that allow individuals to live meaningful, fulfilling lives that do not cause harm to others.
Although originally developed for adults who had engaged in sexual offending, the GLM has been successfully adapted for use with children and young people by G-MAP, a UK-based service. This adaptation, known as the GLM-A, simplifies the model’s language and concepts to make them accessible and relevant to younger audiences. In this version, “primary goods” are referred to as “my needs,” while secondary goods are described as “how I meet my needs.” The eleven adult-focused primary goods have been condensed into eight primary needs that are more suitable for young people: having fun, achieving, being one’s own person, having people in one’s life, having purpose and making a difference, emotional health, sexual health, and physical health.
The GLM-A provides a framework for understanding the needs that drive a young person’s behaviour and informs the interventions required to help them meet these needs in appropriate ways. Interventions are carried out collaboratively, involving the young person and their family or carers, and recognising the importance of the wider social and systemic context (Fortune, Ward & Print, 2014).
In Scotland, the G-MAP model has been implemented through the Safer Lives Programme, introduced in 2008. This programme trains practitioners to use the GLM-A as part of their therapeutic work with young people who display harmful sexual behaviour. Initial evaluations of the GLM-A have been highly positive (Leeson & Adshead, 2013). Practitioners reported that the model improved their understanding of young people’s behaviours, enhanced engagement with children and carers, and provided a motivational and hopeful framework for change. Young people themselves found the model easy to understand and empowering, as it helped them recognise why they acted as they did and what steps they could take to change.
Further research into the implementation of Safer Lives in Scotland (Simpson & Vaswani, 2015) found that practitioners viewed the GLM-A as enriching their practice, sometimes by adding useful tools, and at other times by transforming their overall approach. They appreciated the model’s alignment with person-centred and strengths-based values and welcomed its shift away from a purely risk-focused perspective toward one that fosters growth and rehabilitation.
Despite its strengths, some critics have argued that the GLM focuses too narrowly on individual change and does not give enough attention to the social contexts that influence offending behaviour. McNeill and Weaver (2010) suggest that building social capital—such as supportive relationships, community involvement, and legitimate opportunities for participation—is essential to long-term desistance from offending.
Although the GLM and GLM-A have been applied primarily to individuals engaging in harmful sexual behaviour, the principles are equally relevant to other forms of offending. By focusing on personal growth, well-being, and the pursuit of pro-social goals, the GLM offers a promising framework for a wide range of rehabilitative practices.
In conclusion, the Good Lives Model and its adaptation for young people mark an important shift in offender rehabilitation, moving from a focus on risk and deficit toward one of growth, meaning, and human potential. By understanding and addressing the underlying needs that drive behaviour, the GLM empowers individuals to build better lives for themselves and safer communities for others.
Beyond Barriers 