Stigma is a social process linked to power and control, which leads to creating stereotypes and assigning labels to those that are considered to deviate from the norm or to behave “badly.” Stigma creates the social conditions that make people who use drugs believe they are not deserving of being treated with dignity and respect, perpetuating feelings of fear and isolation.
What Does Liberation Look Like?
- Liberation is the act of setting someone free from imprisonment, slavery or oppression
- In the context of drug use and sex work, liberation is about freedom from thoughts or behavior — ”the way it’s supposed to be” — and how we are conditioned to perpetuate harms to others
What Does Stigma Look Like?
- Stigma limits a person’s ability to access services they need because they feel unworthy of receiving or requesting services
- Stigma creates barriers while receiving services by people feeling unwelcome or judged by program staff that offers services
This exercise can help us understand how approaching people who use drugs with perceptions rooted in stigma and control differ from an approach rooted in liberation and respect.
Beginning at the bottom of the tree, consider how different perceptions would impact core beliefs, and then our actions. When we shift our view to assume that people who use drugs know their own bodies, care for their loved ones and communities, are capable of making rational choices, and can be trusted, our capacity for connection and empathy grows.
Sometimes we don’t understand why people make certain choices or make choices we would not. This difficulty understanding a person’s motivation can lead us to judge, shame and exclude them, which are two major components of stigma. We defeat stigma when we engage in “caring curiosity” — where, instead of judging or letting fear of others drive our actions, we ask genuine questions which are rooted in respect, kindness and the honest desire to support a person who uses drugs.
Tree of Liberation
Leaves: Actions
Create plans together based on their goals
Ask clarifying questions to understand the whole story and needs
Share resources and education for their friends to have
Trunk: Beliefs
“They can do ______”
“They’re telling me the truth”
“They care about the community”
Roots: Perceptions
Capable
Trustworthy
Caring
Tree of Stigma
Leaves: Actions
Ignore the story and project your own agenda
Require mandatory XYZ because “they won’t do it otherwise”
Only talk about the “disease” and not about what they have control over
Trunk: Beliefs
“They’re probably lying”
“They don’t have the willpower”
“They can’t help themselves”
Roots: Perceptions
Not trustworthy
Lazy
Sick
How We Stigmatize People
Pathologizing drug use and patronizing people who use drugs: Implying that people who use drugs are diseased, don’t have control over themselves, or can’t be trusted
Blaming people who use drugs and imposing our own moral judgments: Telling people who use drugs that they don’t care about themselves or their community.
Criminalizing people who use drugs: Thinking someone can be “saved” by hitting “rock bottom” and calling law enforcement or excluding them from programming as a result
Creating fear around people who use drugs, which serves to isolate them: Believing that people who use drugs are morally corrupt, untrustworthy, dangerous to children and the community
Shifting Practices to Reduce Harm
- Actively include people who use drugs and experience marginalization for their expertise when developing new programming or evaluating a current one
- Emphasize building relationships and trust with people who use drugs as important outcomes
- Consider how past histories of trauma, violence, layers of disadvantage and stigma may affect a person’s ability to engage with providers
- Ensure services are grounded in an understanding of how people’s health, priorities and experiences are shaped by the criminalization of drug use
- Ensure all services are provided in a culture of respect and safety within workplace
- Review documents and materials to ensure we are using people-first language/non-stigmatizing language and change them if necessary
Principles of Harm Reduction
What is Harm Reduction?
- Incorporating a spectrum of strategies including safer techniques, managed use, and abstinence to promote the dignity and wellbeing of people who use drugs
- A framework for understanding structural inequalities like poverty, racism, homophobia, classism, etc.
- Meeting people “where they are,” but not leaving them there
We Use People First Language:
- A person is a person first, and a behavior is something that can change — terms like “drug addict” or “user” imply someone is “something” instead of someone
- Stigma is a barrier to care and we want people to feel comfortable when accessing services
- People are more than their drug use and harm reduction focuses on the whole person
Health & Dignity: Establishes quality of individual and community life and wellbeing as the criteria for successful interventions and policies.
Participant Centered Services: Calls for nonjudgmental, non-coercive provision of services and resources to people who use drugs and the communities in which they live in order to assist them in reducing attendant harm.
Participant Involvement: Ensures participants and communities impacted have a real voice in the creation of programs and policies designed to serve them.
Participant Autonomy: Affirms participants as the primary agents of change, and seeks to empower participants to share information and support each other in strategies which meet their actual conditions of harm.Sociocultural Factors: Recognizes that the realities of various social inequalities affect both people’s vulnerability to and capacity for effectively dealing with potential harm.Pragmatism & Realism: Does not attempt to minimize or ignore the real and tragic harm and danger associated with drug use or other risk behaviors.
Harm Reduction Interventions
- Risk Reduction: Tools and services to reduce potential harm
- (h)arm (r)eduction: The approach and fundamentals to reduce potential harm
- (H)arm (R)eduction: A philosophical and political movement focused on shifting power and resources to people most vulnerable to structural violence
