By Raffi Balian, 1956-2007
COUNTERfit coordinator and Harm Reduction champion
June 21, 2016
Systems, ideas and theories are always evolving and the definition of harm reduction is not immune to change. Over the years, there have been as many definitions of harm reduction as the number of people trying to make sense of it. As the discourse on harm reduction is starting to shape public policy, it’s imperative that we come up with a definition that makes sense to people who use drugs and helps them achieve citizenship in its truest form.
This article will not try to do a historical analysis of how harm reduction evolved – there are many scholars who can do a much better job than I. This article will instead propose a new way of defining the theory – a definition we’ve adopted at COUNTERfit
Harm Reduction Program.
A colleague in our Community Health Centre once advised me to use detergents that are less harmful to the environment. “You should use harm reduction in your personal life”, she exhorted. Others have used “harm reduction” strategies to control their urge to buy too many CDs or by using common sense strategies to prevent accidents (such as putting on helmets, or not driving while drunk). In the past decade, people trying to minimize harms associated with alcohol and tobacco have been claiming to use harm reduction strategies too. Is using a helmet a harm reduction strategy? While helmets minimizes harms when you fall off your bicycle, the term harm reduction doesn’t apply to it any more than it applies to vasectomy. Strategies to minimize harms associated with tobacco and alcohol are just that: strategies that minimize harms.
Harm reduction as a praxis, was developed as a response to the use of drugs that are criminalized. Violence, overdose, HIV and other communicable diseases were the driving force that popularized the concept of harm reduction. Usurping the term has grave implications to drug policy and the lives of people who use illegal drugs. Harm reduction, from a drug user’s viewpoint, does not ascribe to traditional “addiction and treatment” theories.
Change is a constant in human existence and so is stress. While a little stress is good for the system, too much stress can be detrimental and constant stress in too short a time could be devastating. In North America and Australia, Indigenous cultures were devastated when white settlers started pushing a new way of living. Until the emergence of so-called “progress”, the Indigenous nations had respect for all living things. They had connection to the land and everything that lived on it. This is not to say that these cultures did not experience war and conflict. For sure they did; but once peace was attained, people returned to an existence that made sense to their way of life. Bruce Alexander’s “Rat Park” research shows that when rats are put in environments that are conducive to their lives (“rat haven”), only a tiny minority of these rats use drugs when given the choice. On the other hand, when rats are put in tiny cages, and drug is presented as an option, most of these rats prefer drugs over food.
In modern times, technology has been changing life faster than ever. People have little time to adjust with the technological changes that are taking place. Coping mechanisms are becoming more important than ever. In an inequitable society such as ours, coping mechanisms differ. Those who have money, knowledge (education), and resources have better coping options – choices that are better-suited for life within the dominant culture. For example, to blow steam off, people with education and money have the option of taking long vacations, have breakfast, lunch and dinner in trendy restaurants, travel to exotic locations, work only 25 hours a week, go shopping, take long baths, or scuba dive. Others visit massage therapists, or expensive psychoanalysts when they feel things are getting out of control.
For most of us, our options are limited to taking short trips, running, playing soccer or racquetball, cooking a healthy meal, drinking a glass of wine (or two), smoking cigarettes, and of course sex (even the kind and amount of sex differs across social layers – but that’s another article). In general, marginalized communities have even less choice in terms of coping mechanism: fatty or sugary food, cheap alcohol, tobacco and illegal drugs being some of them. There are many reasons for this. People with little or no education may have limited knowledge about the determinants of health while experiencing more barriers to attaining them. They also have few prospects to move up the social ladder. Marginalization often confines marginalized communities to long hours of hard work and shitty pay. When one’s efforts are primarily focused towards survival, there’s very little energy left for choices that are considered healthy by the dominant culture.
Unfortunately, coping mechanisms – even healthy ones – can go out of whack. A small percentage of people will have problems in the way they are using these mechanisms. Too much work, driving too fast, drinking too much alcohol, having too much unprotected intercourse, eating too much or too little, spending a big chunk of one’s paycheque on lotteries, injecting 2 or 3 grams of cocaine a day – these are all symptoms of underlying problems with our coping abilities.
For people using illegal drugs, criminalization creates a whole new dimension – the coping mechanism itself becomes problematic because it’s also a constant source of stress. Poverty, violence, corruption, discrimination and social isolation become probabilities especially when the people using these coping mechanisms come from historically marginalized communities. For these reasons, problems with coping should be called socially constructed stigma (SCS) or coping disruptions rather than addiction. At COUNTERfit, ‘addiction’ is considered an “A” Word. We don’t use the term because it stigmatizes our community as diseased people when the system is diseased).
The best way to deal with coping disruptions is through human rights, social justice and health promotion schemes. Human rights and social justice create the environment where coping doesn’t become a major issue for the entire population. Health Promotion helps people to manage their coping mechanisms better.
Getting back to the definition of harm reduction: Should you ask ten needle and syringe distribution program coordinators to define harm reduction, the likelihood is that all ten will say something like this: “Harm reduction is about the reduction of harms associated with drug use”. Almost half of these folks may not use the term ‘illegal’ when talking about drugs, but almost all will think it. All of these organizations will talk about working with people who use drugs “where they’re at”.
I used the above definition for a long time, but not without tribulation. For the outset, this definition seemed quite negative. It presupposed drugs were harmful. I consulted with many front-line workers and harm reduction activists and some proposed a number of alternative terms (drug-related health promotion; Pleasure Maximization, etc.). Finally I realized that there was nothing wrong with the phrase. The mistake was in the interpretation of the praxis.
When we implicitly agree that drugs are inherently harmful, we contribute to the stigma associated with drug use. Not only that, we continue placing the blame on the person who uses drugs. If drugs are harmful, it’s up to the user not to use them. Drugs are value neutral: they can be harmful, harmless, a little of both, or harmful at one time and harmless at another – I can go on and on. For example, opiates are great when one is experiencing mental or physical pain and can kill someone if taken too much. Opiates can also be great fun but also depress REM sleep or be fun when you don’t need to sleep and harmful when you do. The same argument can be made about any drug. ANY DRUG. There are no evil drugs. There are, however, evil drug policies.
Harm reduction should be defined as a praxis (theory + practice) to reduce the harms associated with criminalization of certain drugs. This is an important distinction. This definition shifts the problem on the system rather than the user. It also helps organizations shape how they work with people who use illegal drugs. Organizations that look at drugs as the problem often try to “help” PUD to come off drugs rather than helping them understand where the locus of the problem is and how to negotiate the minefields planted by prohibition.
Another important reason to change the definition of harm reduction to the reduction of harms associated with criminalization is the following: until now, the war on drugs has been a unilateral war on the people who use these drugs. A unilateral war has only victims. As a person who uses drugs, I don’t want to be a victim. I want to be part of the solution and fighting against criminalization provides our community a positive platform to do just that.