Stigmatization & Conditional Acceptance

By Garland Hanson and Olympia Fulcher

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Our acceptance of drug users is conditional, similarly how our acceptance of drugs is conditional. We promote the use of antidepressants, go out to bars on the weekends, and praise recovering drug addicts. We stigmatize non-prescription amphetamines, and ‘hard’ drugs – the stuff we cook, the stuff we inject. Throughout the 1990’s, the dangers of marijuana commercials plagued our T.V.s, depicting marijuana users as lazy, useless, and addicted. A couple decades later, we’ve almost normalized marijuana use. Now marijuana is often described as a non-addictive, pain relieving, anti-emetic medication, prescribed to people that suffer from anxiety to those going through chemotherapy. Changes in state laws have led to changes in our norms and stigmas surrounding marijuana use.

Looking at the transformation in reputation marijuana and marijuana users have had, might we consider that other drugs and other drug users may be unnecessarily demonized and stigmatized as well?

In many ways, drug use has been presented as synonymous with many other stigmatized traits. Drug-users are framed as ‘crazy’ for taking drugs; drug use is associated with violence, gang participation, poor communities and people of color. We create these disproportionate associations based on the drugs and groups we have historically chosen to stigmatize. We don’t really seek to stigmatize the white drug users in Colorado smoking weed recreationally or the white CEOs using cocaine to up their productivity. We take issue with people of color using drugs, even if research shows us that educated white people use drugs as often if not more – than these groups. Additionally, we ignore the role that specific stressors play in leading certain groups to increased drug use – like the homeless population. Addressing our national homelessness issue by investing in rehabilitation, subsidized housing, & job placement, could help us to tackle this disparity in drug use. When drug use is framed as an individual problem, or a problem for only some minority groups, we turn a blind eye to our dysfunctional institutions that do not provide help to those who can’t pay (when those who can’t pay are likely the people who need help most). We feel comfortable ignoring this dysfunction when we ourselves are not the ones in need – when we have generational wealth, expensive college degrees that lead to steady jobs, or a family to turn to – rarely caring to think about the people that aren’t as fortunate.

The movement of harm reduction seeks to treat drug users with respect, as human first, and any problematic drug use as a health issue, not a crime. “If health is a state of complete physical, mental, and social well-being, and not merely absence of disease…”, then treatment should be geared toward growth and development, reducing harm and pain (Einstein, 2007). The more that drug use, and drug users are moralized and politicized, we more easily forget the human using the drug. Politicians have used harsh policy on drugs in order to appeal to the masses, and distinguish themselves from competitors, blaming violence and poverty on drugs (Friedman, 2001). This blame-heavy mentality supports the notion that drug users deserve to be punished rather than helped. Furthermore, even a medicalized approach to viewing drug addiction can have dangerous social implications (Roe, 2005).

In the beginning of the harm reduction movement, there were two schools of thought on how harm reduction should be carried out: the medical group, who believed that harm reduction is a matter of improving the health and wellbeing of the population, and the activist group, who believed that harm reduction is simply one piece of broad and sweeping structural and cultural change targeting racism, classism, and social discrimination (Roe, 2005). Since medical professionals were the “experts” in harm reduction, this group won out over the “immature” and confrontational nature of the activist approach. This caused the community/grassroots/activist approach to be marginalized in later years (Roe, 2005). 

This shift in approach has been criticized by many for a variety of reasons. Critics claim that the medical approach is only a “bandaid” solution — meaning a solution that doesn’t treat the systemic issue, but rather does the bare minimum to mitigate damage (Roe, 2005). The shift in the approach to harm reduction also coincides with a time where society was moving away from exerting overt power over minorities (ex. Jim Crow, segregation, slavery) to more subtle and covert methods of exerting power (ex. 13th amendment, felon voting laws) (Roe, 2005).

This also led to a shift in the concept of “risk” to a self-policing concept: if one is at risk, one is expected to take action of their own accord to mitigate said risk (regardless of how one gained additional risk in the first place). In this new structure, if an addict or person with a problematic drug use issue is reluctant to follow the advice of medical or social programs or is outright resistant, they have essentially brought the harm on themselves, thus releasing these medical/social programs from the responsibility of “fixing” them. This tactic is known as victim-blaming, wherein the victim of an unfortunate circumstance, usually a crime, is blamed for whatever has befallen them. Critics also claim that this medical approach also perpetuates the disease model of addiction; namely, that drug addicts are “disabled” for the rest of their lives, and can never be fully equal to a person that has never used drugs.

When we stigmatize individuals, they internalize this. They feel insecure about projecting stereotypes, insecure about the attention they attract by displaying or discussing the stigmatized trait (Goffman, 1963). This could prevent disclosing drug use to doctors, specialists, and counselors. Destigmatization releases the pressure of performance, pressure of ‘looking’ right, or ‘acting’ right. It gives us room for honesty, leading to proper education and discussion, and the ability to administer meaningful treatment. In order to find value in harm reduction, we must first find value in our communities and our peers, the desire to keep others alive and healthy. We must view health and life as a human right, expanding healthcare coverage, rerouting drug users from prisons to treatment centers. When we limit access to healthcare, and send drug users to prisons for self-medicating, we become the problem. When recovering addicts can’t find a job because of a possession-based arrest, and we push them back into instability, we then promote the cycle of drug-abuse.

“Harm reduction stems from a point of view that considers, firstly, that a drug-free society is not achievable” says professor S. Einstein, PhD (2007). Drugs have been used by humans for ten of thousands of years, it’s theorized that even neanderthals got high. While we shouldn’t strive to live in the past, we should acknowledge the prevalence of specific human behaviors. Just as it is incredibly difficult to stop humans from having sex for fun, it seems equally as hard to stop humans from taking drugs. We can look to state-imposed sex abstinence programs, and we can see their incredibly high rates of teen pregnancies as an answer to the question of how well “just say no” works. “Teens in states that prescribe more abstinence education are actually more likely to become pregnant” (Stanger-Hall, 2011). Similarly, D.A.R.E., a drug abstinence program designed to reduce drug use by over-exaggerating the negative effect of drugs, utterly failed to reduce drug use. In a world where we can’t teach every child to be abstinent from the things that could cause harm, we have to educate them on what drugs really are, what they really do, and how to stay safe in a world where, inevitably, they will run into them one day. 

Some last points to consider, when we discuss harm reduction and its potential benefits, are the potential risks and downfalls of certain intervention measures, in addition to, the informative and valuable perspectives of former drug users themselves. 

For this post, we include our experiences with Kate Stoler, a former addict from Kensington, who now plans to develop a bookstore there focused on recovery for women. At first, when she said safe injection sites don’t solve the problem (of drug use), I almost felt confused. I am an analytical person, and had heard that safe injection sites reduce disease related to intravenous drug use, like heroin. But Kate brought a perspective that only someone who had been in that situation could bring: what if you don’t care if you die? Particularly with opiates, people get so addicted that they become violently ill if they don’t consume their substance of choice. If you felt so sick, like the worst flu times 1000, would you take two trains and 20 minutes to get to the safe injection site? Likely not. 

This demonstrates a key failure with the “medical” mindset: it is not holistic. It doesn’t address key factors like mental health, sexual identity, gender, race, financial stability, and all of the other things that make an individual person’s experience with problematic substance use unique. Instead, Kate focuses on those aspects uniquely, like how women experience addiction and rehabilitation differently from men. Additionally, Kate agreed that the government sponsored programs are almost like an excuse by the government to spend as little money as possible while mitigating the most damage. Kate plans to include a community garden at her bookstore, and she wants to hold women-only meetings to address gender-specific concerns in battling addiction. We thank her immensely for her input on harm reduction :).

References

Cottier, Cody. 2020. “Our Ancestors Got High, Too”. Discover Magazine. https://www.discovermagazine.com/mind/our-ancestors-got-high-too.

Einstein, S. “Harm and Risk Reduction: History, Theories, Issues, and Implications.” Substance use & misuse. 42, 2-3 (2007): 257–65. https://doi.org/10.1080/10826080601141990.

Fitzjefferies, Katherine. 2020. “Cultural Humility: Reflection On Self And Practice Research Data- From A Cultural Perspective”. Naadac.Org. https://www.naadac.org/assets/2416/kathy_fitzjefferies_ac17ho8.pdf.

Friedman, Samuel R., Matthew Southwell, Regina Bueno, Denise Paone, Jude Byrne, and Nick Crofts. “Harm Reduction — A Historical View from the Left.” International Journal of Drug Policy. 12, no. 1 (2001): 3–14. https://doi.org/10.1016/S0955-3959(01)00063-9

Goffman, Ervin. Stigma, Chapter 3: Group Alignment and Ego Identity, pp. 105-125. 

Gomez, Rebecca, Sanna J. Thompson, and Amanda N. Barczyk. 2010. “Factors Associated With Substance Use Among Homeless Young Adults”. Substance Abuse 31 (1): 24-34. doi:10.1080/08897070903442566.

“Map of Marijuana Legality by State.” 2020. DISA Global Solutions. May 5, 2020. https://disa.com/map-of-marijuana-legality-by-state.

McCabe, Sean Esteban, Michele Morales, James A. Cranford, Jorge Delva, Melnee D. McPherson, and Carol J. Boyd. 2007. “Race/Ethnicity And Gender Differences In Drug Use And Abuse Among College Students”. Journal Of Ethnicity In Substance Abuse. 6 (2): 75-95. doi:10.1300/j233v06n02_06. 

“Race And The Drug War”. 2020. Drug Policy Alliance. https://www.drugpolicy.org/issues/race-and-drug-war.

Roe, Gordon. “Harm Reduction as Paradigm: Is Better Than Bad Good Enough? The Origins of Harm Reduction.” Critical Public Health. 15, no. 3 (2005): 243–50. https://doi.org/10.1080/09581590500372188.

Stanger-Hall, Kathrin F., and David W. Hall. 2011. “Abstinence-Only Education And Teen Pregnancy Rates: Why We Need Comprehensive Sex Education In The U.S”. Plos ONE. 6 (10): e24658. doi:10.1371/journal.pone.0024658.

West, Steven L., and Keri K. O’Neal. 2004. “Project D.A.R.E. Outcome Effectiveness Revisited”. American Journal Of Public Health. 94 (6): 1027-1029. doi:10.2105/ajph.94.6.1027.

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