Hey, thanks for blogging my blog – and you’re right, I am an exponent of harm reduction. I totally agree with your assertion about raising expectations – as long as those expectations that we strive for are the clients and not just the service’s or the worker’s. For me, the difficulties in raising aspiration in any sustainable way while labelling the individual an addict or considering their drug use solely an illness are manifest
The context and orientation of services is as you say, critical. While the impetus for change is directed from a political level, its all too easy to negate the choices made by the individual. A focus on criminalising or pathologising drug use is problematic and shifts the emphasis away from individual aspiration, hope and recovery. This is sadly the environment within which many services operate – and in my view a continuing block to a full menu of useful interventions (and particularly those focussed on reintegration) for many individuals experiencing problems with substance use.
Harm reduction is a dynamic philosophy that I do not in any way see being in opposition to abstinence. Good harm reduction requires at its core a recognition of individual volition and self direction as well as an understanding of the impact of environment and culture on the choices available. However the philosophy of harm reduction is vulnerable when there is a shift in the definition of harm from an individual one to a societal or political. Community wide gains from harm reduction are best achieved incrementally through numerous successful individual interventions rather than centrally mandated programmes. Centrally funded harm reduction initiatives need to be cautiously managed to ensure the drive for acceptance of the philosophy (ie through attaching crime outcomes) does not overpower the individual intervention. These comments are of course specifically relevant to the UK situation where harm reduction has been accepted for some time. Where harm reduction is less well developed, different approaches may be more appropriate.
Going to feed the dog now. Have a grand weekend.
I agree that it is important that we not view all heavy drinking or illegal drug use as addiction. The U.S. had its excesses with this in the 1980s when every kids who’s Mom found a bag of weed in their sock drawer was diagnosed with substance dependence. I also agree that the clinician should not be prescribing goals, however when we offer clients services that are filled with hope and success stories, they choose recovery. (Skeptics should visit our detox facility.) As for the difficulty of raising aspirations within the context of addiction as an illness, I don’t see it. We don’t see hope as incompatible with other illnesses and I don’t see a nonjudgemental review of the diagnostic criteria as harmful labeling. Personally, I think that viewing an addict outside of that framework frames them as self-destructive hedonists, making it more a matter of character than health.
However, I think she’s put her finger on the crux of much of the tension between many HR advocates and recovery advocates. If you view drug users as engaging in a lifestyle choice, recovery advocates look like evangelical temperance zealots driven by moral judgement and panic. If you view it as brain disease characterized by loss of control, then long-term strategies that are focused on controlled use or limited to reducing harm constitute professional neglect–similar to treating only the symptoms of a serious chronic illness when treatments to facilitate full recovery (Even if only for a sizable portion.) are available.