Basic HTML Version
‘Complacency has led to the situation whereby
we find ourselves questioning the value of
‘harm reduction’, which is a bit like questioning
the value of pedestrian crossings – sure they
save a few lives, but we can’t measure that,
and people still die on the roads.’
WILL THE LAST ONE
TO LEAVE…
I write in response to the Soapbox
column
What now for harm reduction?
(
DDN
7 February, page 19).
Complacency is at the core of so
many moves towards a reactionary
shift in thinking. This shift in thinking
is not wholly surprising, given that so
much media space is given to fuelling
the fire of anger towards people
described as ‘scroungers’, ‘junkies’,
’winos’, and ‘nutters’.
It is complacency around the very
rights of other human beings to be of
equal value that has led to the
erosion of the fundamental values
that make us a society in the true
sense of the word.
This same complacency has led to
the situation whereby we find
ourselves questioning the value of
‘harm reduction’, which is a bit like
questioning the value of pedestrian
crossings – sure they save a few lives,
but we can’t measure that and people
still die on the roads. The question
raised by Neil McKeganey of ‘why has
harm reduction fallen so far from a
favoured position’ is not vastly
different. The answer is simple and
therefore easily missed. It is a reac-
tion to complexity. Life is complex,
people are complex, and solutions are
not easy to come by, and may not
even exist.
For many in the drug field, this
complacency was a result of many
years of pragmatism and relatively
little reflection. We bathed in the glory
of our successes, moving the goal-
posts at will to redefine our achieve-
ments, but we rarely stopped to
consider the view from the outside.
Conference upon conference of like-
minded people slapping each other on
the back and reporting on success
and achievement, whilst service users
were self-reporting their drug use in a
shared conspiracy with their drug
workers that this reciprocal delusion
could continue unabated.
Then the reality dawned, and we
quickly pretended that we agreed all
along and everyone should join the
revolution – only our revolution was
going to be ‘recovery’. Not quite a
revolution, more a refurbishment. The
problem with this refurbishment is
that it has allowed a voice for dissent
among those who never really liked
the idea of harm reduction, much like
freedom of speech allows a slight gap
for the bigot to express views that can
offend and hurt if that gap is not
policed through political correctness.
I’m not trying to suggest that those
who disagree with harm reduction are
bigots, but there have certainly been
some messages that signal a less
than tolerant tone. The rekindling of
the term ‘clean’ suggests any other
state is ‘dirty’, and ‘addiction’ is
liberally used and rarely defined. Is
this merely semantics? Possibly,
although I believe that sticks and
stones can break bones but names
can cause massive psychological
damage and stigma. But of course,
stigma, for Mr McKeganey, can be a
therapeutic tool in behaviour change.
I’m awaiting the evidence on that one.
He says the harm reduction lobby
have ‘diluted their commitment to
reducing all forms of drug use’, but
surely this is much more about a
growing pragmatism based upon the
evidence that drug use is essentially
not abnormal behaviour. I don’t hear
many harm reductionists saying that
those who choose abstinence are not
normal, but I have heard some
proponents of abstinence say this of
drug users. I find this frankly insulting.
The refocusing of drug services on
the service user is a good thing and I
support the need to re-think our
delivery of services to meet new and
differing demands. What I am highly
suspicious of is using the recovery
agenda to assert the belief that
‘drugs are bad’. This view is far easier
to express publicly and hence the
picture becomes distorted, as those
of us who do not hold this view are
seen as being part of the ‘old drug
system’, ‘liberalist’, ‘politically
correct’, amongst other terms of
derision.
Lastly, Neil McKeganey talks about
those of us who practice harm
reduction and lobby for drug law
reform as needing to ‘temper’ this
support so as to ‘concentrate on
individual and public health
protection’, but this would have been
contradictory to the amendment of the
Misuse of Drugs Act that allowed for
provision of a wide range of injecting
equipment. It is very conceivable that
part of the fuelling of hepatitis C in
the UK was as a result of restrictions
in equipment given prior to this
amendment, not as a result of the
failure of needle exchanges.
I applaud
DDN
for giving a voice to
Neil McKeganey even if I disagree with
almost everything he has to say. My
only reservation is that whilst I can
have my chance to give my views
here, in a wider society context my
soapbox is a lot smaller than his and
it is becoming a lot less stable to
stand on.
Colin Tyrie, senior public health
development advisor in substance
misuse, Manchester
RIDING FOR A FALL
In asking the question of whether it
will be possible to combine recovery
with harm reduction, Neil McKeganey
highlights a persistent failing of the
drug and alcohol field. If we focus on
the wellbeing of those who make use
of our services, then not only does
this combination become possible, it
becomes inevitable.
Clearly there are many for whom
drug or alcohol use has become so
problematic that the goal of becoming
drug or alcohol free is extremely
appealing. However, it is precisely
because there are so many that
struggle to achieve this goal that we
also need harm reduction approaches.
There are also those whose goal is to
control and moderate their drug or
alcohol use.
Unless we take the time and effort
to understand the goals of services
users, we have little hope of being
able to support them effectively.
If we allow our own views and
opinions to set the treatment agenda,
we are likely to fail. I do not believe
that it is the role of drug and alcohol
agencies to either promote the
opprobrium associated with drug use
or to promote a drug-using lifestyle
and campaign for changes in
legislation.
There is a vast body of research
evidence that should guide treatment
and interventions – particularly in
relation to substitute prescribing.
However, to be in a position to accept
any offer of treatment or support,
problematic drug or alcohol users
must engage with the service and this
will only happen if the service is seen
as relevant to their issues rather than
imposing its own agenda.
www.drinkanddrugsnews.com
24 |
drinkanddrugsnews
| 7 March 2011
LETTERS
Letters |
Comment