Tuesday, February 5, 2013

Beyond Harm Reduction: The Drug User Empowerment Movement

     One of the defining characteristics of the term "harm reduction" is that it can subjectively have many multiple meanings to the various groups and individuals involved in it's implementation as a health care strategy. Any treatment center or rehab can claim to be following a "harm reduction policy" despite the mode of treatment they employ being in actuality harmful to drug users including mandatory treatment that is not evidence based (AA/NA), or using psychologically traumatizing "behavior modification" techniques. Fortunately, harm reduction policies and procedures that encourage drug users to be autonomous and advocate for themselves are out there (peer/ drug user run needle exchanges, peer distributed naloxone/Narcan, and peer facilitated support groups for example) and should be encouraged at every level by drug user activists and their allies. The greatest obstacle to the broad implementation of truly helpful to drug users harm reduction policies is of course the systematic persecution of drug users via the enforcement of prohibition. In other words the most effective harm reduction policies will never be put into practice if drug users do not have the right to receive them.
    More to follow....


  1. Hiya Johnny, just popping over to have a browse at your musings. Thanks for the support, on my page and things.

  2. I totally I agree with your post. I salute the devotion of rehabs to help regain life. However, this can't be under harm reduction.I think the higher granting body should strategized well the implementation of such. And one more, family intervention is also important in the picture.

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  4. Interesting post. Couple of thoughts: you're right in that unless the drug user is setting the agenda for his or her "recovery" in harm reduction, the result is a situation where the full power of harm reduction cannot be realized. Most attempts to implement large scale social innovations are met with resistance. So what does one expect? Maybe we are where we should be? I like to take a structural approach to the analysis of the “where are we?” and “where are we going?” questions.

    Harm Reduction is an essentially a “new middle class” movement (see Basil Bernstein(1) for the precise definition of this term), so it follows that class issues cause people in “rehab” to practice' harm reduction but not really believe in it. For what we see in many harm reduction organizations are middle class people at the top (executive directors, clinical supervisors and the like) but on the front line you find workers making slightly over minimal wage or working part-time. While not working class in the classical sense (there's a fair amount of new middle class values in the way these front line jobs are structured - still, a clearly demarcated division exists). Front line workers are over-worked and stressed and may be impeding true harm reduction.

    The crazy thing is that resistance also exists in the layer of the old middle class who has nominal authority in harm redux organizations and drug users (nurses, doctors, attorneys, judges, so-called criminal justice, etc. – in short, professionals). So you have three layers of workers and ideologies (at least) mucking up the process. Another narrative or way of thinking this through is that until a social worker or a doctor (or a peer educator for that matter) can run a group in a harm reduction program that has enough institutional authority to keep someone out of jail, the way that a drug court can, the bottom line for working class people is harm redux is not viable. You correctly identify the drug war as a problem. Drug courts are part of that structure or apparatus called ‘recovery’. I hope your blog can provide an outlet for the exploration of these ideas as we flesh out what to say after the slogan, "end the war on drugs' fades and the demonstrators go home carrying their protest signs.

    (1) Bernstein and the middle class by Sally Power, Geoff Whitty British Journal of Sociology of Education (2002), Volume: 23, Issue: 4, Publisher: Routledge, Pages: 595-606 DOI: 10.1080/0142569022000038440

    (The views expressed above are my own and do not reflect the views of the SF-DUU or the Harm Reduction Therapy Center. They are shared in the spirit of creating intellectual and political inquiry and theory for the drug user liberation movement . – Badlydrawnbear, Feb. 2013)