A friend shared this interview with Susan Stellin and Graham MacIndoe with me yesterday. Susan and Graham do a lot of public education about addiction and drug problems, including their traveling exhibition Reframing Recovery. It’s rare to hear a lengthy discussion that communicates such sincere respect for both recovery and harm reduction. They bring really valuable and interesting perspectives rooted in personal experience, public health, and regular contact with people at the community level. It’s worth your time.
The Politicization of Harm Reduction?
At one point in the interview, one of the interviewers asked them to comment on the challenges of discussing harm reduction in the context of politicization of the term.
I could be wrong, but I imagine the interviewer was thinking about Fox News stories that frame harm reduction as liberal lunacy.
I’ve expressed concern for some time about drug policy becoming a front in the culture wars. In 2013, Mark Kleiman described some of the subtle and not-so-subtle ways this tendency appears:
The question about my own use or non-use of pot always comes up, and I always answer the same way, with a polite (I hope) “None of your business.” I don’t think there’s any ill will involved in asking the question: journalists simply want to “place” their sources culturally on the hippie-to-jock spectrum. But I want to resist the whole idea that drug policy should be a clash of cultural identities rather than a serious discussion of harms and benefits.
In the 10 years since Kleiman said this, changes in drug policy and drug problems have accelerated and political identities have become increasingly salient to Americans. So, the impulse to place advocates, programs, interventions, and policies on a cultural spectrum has not disappeared, but the hippie-to-jock cultural spectrum has been replaced with a right/left or conservative/progressive spectrum.
For me, it’s hard to think of how this kind of coding on a political or culture war spectrum wouldn’t be destructive.
Should harm reduction be politicized?
That might lead one to conclude that depoliticization of harm reduction is desirable.
There is no doubt that resistance to harm reduction is often rooted in stigma and that advocates, programs, interventions, and policies are coded based on clashing culture war identities.
While those destructively politicized reactions are prevalent and often attention-grabbing, they do not represent the whole of questions and concerns related to harm reduction programs, interventions, problem-framing, and goals.
Many of the questions and concerns about harm reduction relate to the political and philosophical ambitions of harm reduction itself.
This framing situates Risk Reduction and (h)arm (r)eduction as the interventions and strategies to reduce risk of harms like overdose deaths and disease transmission. On the other hand, (H)arm (R)eduction represents a much more ambitious philosophical and political movement.
So, disagreement about harm reduction can be about (h)arm (r)eduction or (H)arm (R)eduction, and those are two very different disagreements.
I’m of two minds on this. On the one hand, I recognize that a lot of good has been accomplished with the premise that everything is political. On the other hand, I frequently see questions and concerns about the philosophical and political ambitions of (H)arm (R)eduction are often coded as opposition to (h)arm (r)eduction and placed on a cultural spectrum as anti-science, anti-public health, anti-social justice, or pro-drug war.
This dynamic ends up creating something similar to a motte-and-bailey fallacy where (h)arm (r)eduction and (H)arm (R)eduction are conflated and distort disagreements.
I don’t have a solution to offer, other than distinguishing between (h)arm (r)eduction and (H)arm (R)eduction when disagreements arise, and recognizing that the existence of (H)arm (R)eduction complicates the framing of harm reduction as public health, pragmatic, and science-based. Failing to do so probably accelerates destructive politicization.
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