Drug Use Stigma and Harm Reduction
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Drug Use Stigma and Harm Reduction

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DRUG USE STIGMA AND HARM REDUCTION ...

DRUG USE STIGMA AND HARM REDUCTION

Goals and Objectives

- Gain a better understanding of the negative effects of stigma on people that use drugs.
- Reflect on the how stigma and stereotypes are generated.
- Examine ways in which access to and provision of services can be affected.
- Consider ways to reduce stigma and improve the well being of people that use drugs.
- Briefly look at the philosophy and practice of harm reduction.

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  • Source: Harm Reduction Coalition (harmreduction.org)
  • Individuals told us how they trusted the outreach workers to keep the information they shared with them confidential.This trust can be seen in the following quotes.

Drug Use Stigma and Harm Reduction Drug Use Stigma and Harm Reduction Presentation Transcript

  • Drug Use:Stigma, Stereotypes andHarm ReductionJune 2013
  • Goals and Objectives• Gain a better understanding of the negativeeffects of stigma on people that use drugs.• Reflect on the how stigma and stereotypes aregenerated.• Examine ways in which access to and provisionof services can be affected.• Consider ways to reduce stigma and improvethe well being of people that use drugs.• Briefly look at the philosophy and practice ofharm reduction.
  • 3Group GuidelinesPurpose:To build a safe, respectful, and supportive learning environment for theworkshop.Some of you have chosen to be here, while some of you have been mandatedto be here by your work.We value diversity and learn from comparing and contrasting experiences.Some participants may have a personal connection to the issues we will bediscussing and we should acknowledge this.Everyone participates in their own way.Risk taking and self-disclosure is encouraged and supported.Everyone has the right to pass.All voices are heard.Use “I” statements.Everyone uses their own strengths and resources.One person speaks at a time.Confidentiality is maintained but not guaranteed. (context of coworkers andpeople you know outside of work)Learning is a process. Open yourself to the possibilities.Step Up, Step Back
  • What is your definition ofmoderation?
  • 5What do you notice about these pictures?
  • Stereotypes, Stigma &Discrimination• Stereotype– A thought about specific types of individualsor certain ways of doing things, which may ormay not accurately reflect reality.• Stigma– A belief that one does not deserve X/Y/Z...• Discrimination– Being denied something (e.g., service or ajob).
  • Anonymous Survey• Consider the following statements…• There are no right or wrong answers.• We are not collecting your responses andyou do not need to put your name on thehandout.From HRC (http://harmreduction.org) Adapted from Using Harm Reduction toAddress Sexual Risk with Drug Users and Their Partners, HIV Educationand Training Programs, NYSDOH AIDS Institute, by Joanna BertonMartinez, August 2009. Some of the statements on this exercise wereborrowed from Project Implicit and their Implicit Association Tests,https://implicit.harvard.edu/implicit/
  • Consider the following statements. Either in your head oron paper mark the box that most accurately reflects yourresponse to the statements below.Strongly Agree Agree Disagree Strongly Disagree• Although I dont necessarily agree with them, sometimes I have prejudiced feelings(like gut reactions or spontaneous thoughts) toward drug users that I dont feel I canprevent.• I understand the experience of being stigmatized as a drug user.• Sometimes I am uncomfortable around people who are very different from me.• It is not appropriate for me to talk about my drug and alcohol use with clients.• I trust drug users just as much as I trust non-drug users.• If a woman is pregnant, she has a responsibility to stop taking drugs.• Drug users have a difficult time practicing safe sex consistently.• Drug users have meaningful participation in developing policies and programs at myorganization.• I know how to avoid language that stigmatizes drug users.• Although it is hard to admit, I sometimes judge people who cannot stop using drugs.
  • People Who Do “Drugs”• Drug use is a powerful source of stigma anddiscrimination.• The stigma attached to drug use may bereinforced by the fact that it is an illegal andcovert activity, and that there is no legalprotection available to people who use drugs.• There are also stereotypes of drug users, such -“junkies” and “bad” when in fact many drug usersare employed, bring up families, are financiallystable, are good neighbours and good friends.• Alcohol as a drug?
  • “Hierarchy” of use and stigma…• Which drugs and which drug users are:– Most stigmatized?– Least stigmatized?– Why?
  • Judgments can be based on…• Legality• How they are taken (smoked; injected; snorted…)• Frequency of use• Class of people• Impact on personal health• Impact on social circles• Personal experience• Media
  • People Who Use Crack Cocaine• People of all income levels use crack for avariety of personal and systemic reasons.• Ongoing myths and misconceptions thatcharacterize crack users as chaotic anddangerous, coupled with the realities of apowerful addiction that can be difficult tocontrol, have contributed to the intensestigmatization and marginalization of people whouse crack.
  • People Who Use Crack CocaineHomeless adults who use crack face discrimination andpoor treatment from service providers.• 50% of homeless adults who use crack said they had been judgedunfairly or treated with disrespect by a health care provider in thepast year.• The most common reasons people felt they were discriminatedagainst were because of their use of alcohol or drugs or becausethe health care provider thought they were drug-seeking.• 24% of homeless adults who use crack reported having had at leastone negative experience with hospital security, including being toldto go away, verbally assaulted, physically removed or beaten up.The Street Health Report 2007 Research Bulletin #3: Homelessness & Crack Use.Street Health. Toronto: October 2008.
  • Ontario Needle Exchange Data- OHRDP Wave I
  • People Who Use Injection Drugs• Discrimination against injecting drug users(IDUs) is widespread, especially with-inhealth care:– Some health professionals refuse to provideproper medical care or access to socialservices.• IDUs are also likely to be discriminatedagainst by the police, not just because ofthe illegality of drug use, but also becauseof their status as “second class citizens”.
  • People Who Use Injection Drugs• Prejudice and discrimination against IDUsmakes those not yet infected with HIV andHCV more vulnerable, facilitating thetransmission of HIV and HCV infection.• People who have acquired HIV throughinjecting drug use face a double stigma:– They are marginalized and discriminatedagainst on the basis of their drug use, as wellas their HIV status.
  • Ontario Needle Exchange Data- OHRDP Wave I
  • Forms of StigmaThe next few slides are adapted formThe Harm Reduction Coalition (harmreduction.org)• Stigma from individuals/society• Institutional stigma• Self stigma (internalized)• Stigma by association
  • Stigma from Individuals/Society• Labeling and avoidance− People lock up their valuables when a druguser comes over.− The person on the street is called a “crackhead”.− People assume “junkies” don‟t care abouttheir health.− Families / friends disown people or cut themoff…
  • Toronto Drug Strategy Survey• “My brother doesn‟t want to talk to me because I‟ve used[drugs].”• “I‟m outcast from the family because I‟m an alcoholic.”• “Your mom, your dad, your brother, your sister… theysay you‟re a worthless piece of crap, and they wantnothing to do with you.”• “My family, that‟s where I get it all from. I‟m a whore, I‟ma thief, I run the streets, I‟m a crackhead, I‟m dirty, I‟m nogood."
  • Institutional Stigma• Employers believe drug users won‟t bereliable.• Landlords won‟t rent to you.• Healthcare providers:• Believe drug users aren‟t reliable for treatment (re-infection; won‟t comply with medications)• Emergency departments believe people are “justdrug seeking”• Stigma  Discrimination
  • • “They won‟t even give you a pain killer because theytake one look in your eyes and say, “Oh, you‟re adruggie.”• “When you have alcohol and drug problems, it‟s hard toget housing…unless you can get it by doing paper workonly – if they don‟t see you.”• “I‟ve been thrown out of the hospital. I‟ve been thrownout in a hospital gown by security guards.”• “When I walk outside, the police jack me up because I‟ma drug user. It‟s not right.”
  • Self Stigma (internalized)• Asking for help means admitting to themselvesand others that they are one of those „hopelessaddicts‟ and acquiring that label and all thatgoes with it.• It‟s my fault, I‟m diseased, bad, what‟s the pointof doing XYZ (housing, medical care, drug tx,etc.)?
  • Stigma by Association• HCV+ = drug user• Access needle exchange = drug user• Go to HCV support group = drug user• Working with drug users = stigma• Drug user in the family = stigma
  • • “Sometimes being black, you can‟t bechillin‟ with people on the street. „Cause onmy street, if I‟m seen chillin‟ with certainwhite people the cops would just pull measide and see if I‟m selling crack orsomething.”• “I‟m Native and they assume I have analcohol problem. They figure I‟m a drunkenIndian, which is pretty awful.”
  • Key Elements ofDrug Related Stigma• Blame and make moral judgments• Criminalize• Pathologize• Patronize• Fear and Isolation
  • Key Elements ofDrug Related Stigma• Blame and moral judgment• “just say no”; your own fault for getting HIV / HCV;weak-willed; you don‟t care• Criminalize• drugs = bad  get tough  punish• Incarcerating drug users for non-violent crimes vs.resources for supportive services• Pathologize• something is wrong with drug users; they can not helpthemselves…
  • Key Elements ofDrug Related Stigma• Patronize• Drug users often told what they should do, or whatthey need, as opposed to seeking input and involvingthem.• Fear and Isolation• Drug users are “scary”;• Fear-based public education campaigns;• People afraid to talk about drug use; HIV; Hep C• People become isolated, hide their behaviour, or arenot honest with families, friends or professionals,such as doctors or counsellors
  • “Once a junkie, always a junkie.”StigmaStereotypes/LabelsExpectations/RolesLimitedOpportunitiesInternalized &ReinforcedJulianBuchanan,SocialInclusionUnit,GlyndwrUniversity,Wrexham,LL112AWCycle of Drug-Related Stigma
  • “Once they put it in your head so manytimes, you hear it over and over. It‟s like arecording in your head that won‟t stop.Like, “I‟m a crackhead, I sell my body.”Once you keep hearing this recording overand over, this is what you start to believe.You start to believe this is what you are,and you‟re worthless.”
  • Implications for Clients andProviders• Willingness to access services• Risk and behaviors• Self-worth• Relationships and trust• Funding
  • Willingness to Access Services• Discourages access to prevention,testing, case management, healthcare services.• Feelings of shame andworthlessness also prevent peopleaccessing treatment because theyfeel they are „not worth botheringwith‟.
  • Risk and Behaviors• Less likely to access prevention services; don‟tdisclose drug use to health/social serviceproviders; discourages disclosure of HIV/HCVstatus.• Increases risk for overdose if people use alone.• For people who can “pass”, the potential stigmameans they may have even less access toservices than people who are so stigmatizedalready that they “don‟t have anything to lose”.
  • Self-Worth• Less likely to make changes aroundreducing harmful behaviors, makingother positive changes such asreducing use, finding housing oraccessing medical care.
  • Relationships and Trust• Assumptions are made by health andsocial service providers:– e.g., they won‟t show for appointments; beadherent with treatment; follow through withreferrals; abide by rules of agency• These reinforce stigma, lowerexpectations, and present barriers torecovery and reintegration:– e.g., don‟t call them back; hard to find a job
  • Funding• Stigma effects political will to provideadequate funding and programs forpeople that use drugs, especiallyIDUs:–They‟re getting HIV/HCV even witheducation; Shouldn‟t they know better?;If they don‟t care/why do we?
  • Drug Related Stigmahttp://harmreduction.org/issues/drugs-drug-users/stigma-drug-use/
  • Things we could do…• Put a human face on the issue ofsubstance use• Train and educate professionals aboutsubstance use• Educate the public about substance use• Change our language• Use art to reduce stigma• Build on existing effortswww.toronto.ca/health/drugstrategy/reportsandfactsheet.htm
  • VIDEO“Count the Costs Series: Promoting Sigmaand Discrimination”- Hungarian Civil Liberties Unionhttp://drogriporter.hu/en/stigma
  • Thinking about your own use.• Take a few minutes by yourself to answerthe following questions.• Then discuss your responses withsomeone else.• Remember to respect each other‟s privacyand only share what you feel comfortablewith.Adapted from “Under the Influence”, Canadian AIDSSociety, 1997
  • Working by yourself, answer thesequestions:• Do you drink /use substances? If so, where, how much,how often, for what reasons? If not, why not?• What did you learn about substance use when you weregrowing up?• What are your attitudes now about substances?• What do you experience when you see a man under theinfluence of a substance? A woman? Is there adifference?• How do you distinguish between social drinking, the useof alcohol in moderation and heavy drinking? Do othershave a different way of measuring?
  • • With a partner discuss your responses to part A.Respect each other‟s privacy and share onlywhat you feel comfortable with. Here are somequestions to guide the discussion:– What have you learned about yourself regarding yourattitudes, values and beliefs about substance use andsex?– How did you feel responding to these questions?– How do you think your client might feel when you askquestions about their substance use and sexuality?– Have you identified any biases? If yes, what can youdo about them?– What are you most uncomfortable with?– Are you aware of what you do not want to share andwhy?
  • How can we address drug use?• Some communities have developed strategies toaddress issues relating to substance use.• These typically have “4 pillars”:• Prevention• Harm Reduction• Treatment• Law Enforcement• All four are needed to effectively respond tosubstance use issues.• Funding heavily weighted to Law Enforcement– 70-90% of budgets
  • •Needle exchange•Detox•Drug Treatment•Mental Health•Social Workers•Medical Care•Housing•Food•Employment•Police•Courts•PrisonsWhich approach is likely going to be more helpful?
  • Resources and Priorities271582110 10Addressing Illicit Drug Use Canada: 2004-2005($368 million)Law EnforcementTreatmentResearchPreventionHarm Reduction
  • Currently (since 2006)• Impact of localized/municipal policies– e.g., uneven distribution of safer crack kits; problemsestablishing methadone clinics• Federal (Canadian) Anti-Drug Strategy– Changes to policies and legislation• e.g., cancellation of safer tattooing project in prisons– Changes to sentencing for drug related crimes– Research, political and scientific debates– Example of current prevention (not4me.ca)– CSSDP mirror site: not4me.org
  • Harm Reduction?Media and Public Perception
  • Harm Reduction?• Limited understanding and misconceptions• For example: Needle exchange– Not just needles– Many other services and connections• Programs; policies; practices• Programs and supplies are tools forengagement• It‟s a philosophy...
  • 53Harm Reduction as we know it…• Sun Screen• Condoms• Seat belts• Bicycle Helmets• Designated driver• Blood alcohol levels• Nicotine patches/gum• Needle Exchange
  • Harm Reduction in a Nutshell• We can never stop the use of drugs, butwe CAN keep people safe.• Drug use should be treated as a healthand social issue, not a legal one.• Non-judgmental education based on factsand science, not opinions and morals.
  • • Neither for or against drug use.• Implied consent to use drugs.• Anti-abstinence.• “Don‟t ask, don‟t tell”.• “Trojan horse” for drug legalization.• “Anything goes”.What Harm Reduction is not…
  • 56Stages of ChangeMAINTENANCEACTIONPRE-CONTEMPLATIONCONTEMPLATIONPREPARATION
  • Harm Reduction StrategiesEmphasize practical, short-termimprovements, whether or not they can be shownto reduce drug use:• Injecting daily but getting connected to a doctor for thefirst time.• Still smoking crack daily but now using own pipe andnot sharing.• Showing up to 2 appointments out of 4, versus nevercoming in before.• Learning to eat soft foods when high.
  • “Risk Reduction”Self-directed strategies that can help peopleavoid:• overdoses• bad highs• negative health effects (e.g., dehydration)• missed commitmentsAdapted from: “Greenspan, N.R., et al. “It‟s not rocket science, what I do”: Self-directedharm reduction strategies among drug using ethno-racially diverse gay and bisexual men.International Journal of Drug Policy (2010), doi:10.1016/j.drugpo.2010.09.004”
  • 5 Risk Reduction Tips1. Rationing2. Rules for selecting and mixing3. Controlling quality4. Following guidelines during use5. Maintaining a healthy lifestyle
  • Rationing• Limiting or regulating the quantity and/orfrequency of use in a particular setting, orover a given time period.– “I limit myself to two pills a night.”– “I don‟t party every weekend.”– “I need time to recover before work onMonday.”
  • Rules for selecting and mixing• Which drugs you will use.– Certain characteristics maybe reasons to choose or avoidspecific drugs:• “It doesn‟t leave me hung-over.”; “I can afford it.”• “I won‟t do that because it‟s illegal.”; “I don‟t like speedy drugs.”• How you will take them.– Method of consumption can be a deterrent:• “I would never stick anything up my nose.”• Which drugs you can use at the same time.– Physical harms are often reason to avoid specific drugs orcombinations:• “If I mix these two I could pass out.”• “This drug won‟t mix well with my prescription.”
  • Controlling quality• To ensure, as best you can, the quality of drugsused.– Obtaining drugs from a “reliable source”• Get to know your dealer– Using drugs that have been (safely) used by others• Ask around: “Peer Reviews”– Trial & error and inspection• Get to know how drugs look, taste, smell• Become familiar with how they feel in the body and howlong the effects last
  • Following guidelines during use• Drinking water when partying– Especially in hot environments or when physicallyexerting yourself• Using with people you trust and haveexperience– They can help if you have a problem• Not sharing drug use equipment– To avoid HIV and Hep C but even common coughand cold viruses• Watch out for your drinks– To prevent deliberate or accidental contamination
  • Maintaining a healthy lifestyle• Eating, resting, sleeping• Drinking water– Not sharing water bottles• Taking vitamins and other supplements
  • Drug, Set and SettingThree interrelated factors affecting substance use:• The substance being consumed (Drug)• The person taking the substance (Set)• The context in which it is taken (Setting)
  • DrugWhat substance(s)?• The specific pharmacology of the substance(s)– Effects on physiology and neurochemistry.– Half-life: How long does it take the body to eliminate it?• How much is taken– Potency.– For some drugs you can take tiny amounts, others require a lot.• How it is taken (route of administration) affects:– How quickly the feeling “comes on”.– How intense it feels.– How long it lasts.• Quality of illicit substances– It may be hard to know what you‟re getting; the ingredients can includeanything. What are they cut with?– A dealer may say a substance is one thing but sell something else.– It may look like the stuff from last time but it might be stronger orweaker, or have different ingredients.
  • SetWho is taking the substance?• Size and body weight.• Physical, mental, psychological state.• How tired they are.• Their mood before they use.• Their reason(s) for using.• Genetics.– How does their body metabolize drugs?• Experiences with this or other substances.– Tolerance; Habituation; Sensitization• Expectation, or anticipation, of how the substance willfeel or effect them.• Did they eat recently if swallowing a drug?• Are they using other substances at the same time?
  • SettingWhat context is it being taken in?• Where are they?– Alone; with friends; with strangers?– Indoors or outdoors?– Quite setting or lots of people and noise?• What time of day?• What type of music is playing?• Rules and regulations.– Community and social attitudes towards certainsubstances or ways or taking them.– The legal status of different substances.
  • Drug : Set : SettingDRUGSET SETTINGUpper/Downer/Hallucinogen/Strength/Purity/CostPhysicallocation/ Whoelse is there/Socio andcultural normsPsychologicalstate/ Physicalsize and health/Reason(s) forusing/ FinancialsituationExperience& Risks
  • Routes of Administration• Different methods of administration affect the intensity andduration of the high, and pose different advantages and risks.• Smoking / Inhaling• Injecting• Intra-venous• Intra-muscular• Subcutaneous• Insufflation (snorting) / Hooping (suppository)• Sublingual (under the tongue)• Transdermal (through the skin)• Swallowing / Ingesting• Placebo effect / Contact high
  • Smoking / InhalingConcerns:- Burns to lips and mouth(with certain substancese.g., crack).- Damage to lungs andairways.- Quick „come-on‟ canincrease the „rush‟ andpotentially makes usingmore addictive.Advantages:- Easier to titrate dose.- Effects felt rapidly.
  • Injecting Concerns:- Infection through re-using orsharing equipment.- Abscesses.- Easier to overdose.- Finding a safe space.Advantages:- More “bang for buck”.- (More intense high.)
  • Snorting / Hooping Concerns:- Sharing straws, bills andbumpers can transmit alltypes of germs from thecommon cold and flu toHepatitis C.- Damage tonasal/anal/vaginalmembranes.Advantages:- Quicker and easier toadminister.
  • Swallowing Concerns:- Harder to measure dose.- Drugs are absorbed moreslowly through the guttherefore the positive andnegative effects of the drugstend to be less extreme;however, they tend to lastlonger.Advantages:- The risk of getting HIV orthe Hepatitis C virus (HCV)is greatly reduced (almostno risk) from swallowing adrug.
  • Safer Crack Kit•Alcohol swabs•Pyrex-glass pipe•Rubber mouthpiece•Heat resistantmetal screens•Chopstick• Helps preparescreens•(Lip Balm)
  • VIDEO: Step-by-step demonstration of safer crack smoking:http://www.hepcinfo.ca/en/resources/safer-crack-smoking-demo
  • Safer Injection Kit•Alcohol swabs•Cookers•Sterile water•Cotton filters•Needles/syringes•Tourniquet•Safer injectingtips•(Vitamin C)
  • 78VIDEO: Step-by-step demonstration of safer injection:http://hepcinfo.ca/en/resources/safer-injection-demo
  • Cannabis Risk Reduction• Know your source.• Be careful about mould and bacteria.• Eating poses lowest health risks, though harderto titrate (manage) dose.• Use with people you trust.• Be mindful of smoking public spaces.• Avoid getting high and driving.• Smoking increases risks of pulmonary disease.– Try a vaporizer instead of smoking.
  • Cannabis Risk Reduction• Vaporizers offer and alternative to smoking.• Cannabis is heated to the point THC vaporizes but theplant material is not burned.Cannabis before (left) andafter (right) vaporization.This vaporizer relies on convectionrather than conduction.
  • Vaporizer vs. Smoking• Vaporizer after 2 months use (left)• Pipe after 2 weeks use (right)
  • Medicinal Cannabis in Canada• Federal Permit• Compassion Clubs• Rules will be changing in 2014
  • Harm Reduction Initiatives• Street Outreach• Education, providing achievable options• Supplying condoms• Moderate/Controlled using strategies• Needle Exchange and Safer Inhalation Programs• Tolerance zones (e.g., Supervised Injection Sites)• Methadone Maintenance Programs• Prescription of heroin and other drugs (e.g., NAOMI)• User groups, peer support• Law-enforcement cooperation
  • Alcohol Harm Reduction• Managed Alcohol Programs:• Wet / Damp / Dry• Shelter Based Alcohol Harm Reduction Programs:• Hamilton, Ottawa, Toronto, Thunder Bay• Ottawa Study:– Shelter-based Managed Alcohol Administration to ChronicallyHomeless People Addicted to AlcoholCanadian Medical Association Journal (CMAJ), 174(1): 45-49, 2006– Significantly decreased Emergency Department visits and policeencounters• Listen to a conversation about a program in Thunder Bay, Ontario:http://www.cbc.ca/video/watch/AudioMobile/SuperiorMorning/ID=2309351971
  • VIDEO: Shelter-based ManagedAlcohol Program (Ottawa)
  • Reaching OutHarm Reduction Programsare often the first or onlycontact “drug users” havewith health or socialservice providers.
  • Outreach workers:• Listen to you• Provide moral support• Are someone to talk to• Are treated like a friendOutreach Workers“Someone to listen to me”
  • • The recurring theme of the personalrelationship with outreach workers– Outreach workers treat you like a person– Outreach workers are trusted– Outreach workers are comfortable and friendlyWhat makes outreach programsunique?
  • “I am very open with xxx because he makes me feelcomfortable, isn‟t judgemental.”“ Family things and issues. You get a relationshipgoing and it is easy to talk to them about anything.”“With life problems – relationships, trouble withfamily, relapsing, staying clean, being stressed out,nightmares.”Trust with Outreach Workers
  • “I have changed my view from looking at myselfas someone who doesn‟t have anything tocontribute or isn‟t worth anything . I see myselfas someone who can put back into thecommunity and can contribute to thecommunity. I can look for jobs, I can find a joband contribute; even with my drug use I canstill do things. It has given me back my life.”Improved self-worth
  • Harm Reduction Practice Tips• Be non-judgmental and self-aware.• Be patient with yourself and the client.• Be realistic in your expectations.• Listen well – actively and empathetically.• Remember you are witnessing their important eventsand struggles. You will be affected.• Regular participation in the harm reduction process canreduce “magical thinking” or dissociative behavioursassociated with substance use.• Create an opportunity for the client to think ofthemselves as part of a community.
  • Harm Reduction Practice Tips• Interventions that imply pathology or require the wearing of labelsare not useful.• Keep asking what‟s working and why? What doesn‟t and why not?Who is being reached? Who is not?• Experience tells us that a higher level of participation by the client(over time) often means more sustained change.• Be objective, reflective, a mirror. Resist evaluating or projecting.• Ask yourself: What do you want to achieve? What do you want toprevent?• Ask the client: What do you want to achieve? What do you want toprevent?• Empowerment adds to peoples‟ skills and abilities.
  • How Does My Language Reflect My Values?• “Drunks”, “Alcoholics” →– “Alcohol users”, “Individuals with Problematic Alcohol Use”• “Drug Addicts”, “Junkies”, “Crack Heads” →– “People Who Use Drugs”, “Individuals Struggling withDrug Addiction”, “Active Substance Users”, “A PersonLiving with an Addiction”• “Drug Abuse”, “Substance Abuse”→– “Drug Use”, “Problematic Substance Use”• “Clean Needles”, “Dirty Needles”– “New”, “Used”• “Hooker”, “Prostitute” →– “Sex Trade Worker”
  • 94
  • Key Points• Focus on risks, not the substances.• Focus on ways to reduce the risks, whichmay/may not include stopping thesubstance use.• Focuses on “any positive change”.• Support client‟s right to choose theirgoal(s) to reduce risks.• Treat your client the way you would wantto be treated.
  • 96BillBill is a 52 year old gay man who has had HIVfor 18 years. He has had numerous depressionsover those years and has chronic low energyand fatigue. 8 months ago his roommatesuggested he “smoke a bowl” of crystal methto help pick him up. He tried it and got hisapartment cleaned for the first time in months.Now he is partying regularly with other poz-guys and having lots of sex for the first time inyears. Bill is now looking to reduce his use butis having trouble doing that.
  • Contact UsNick Boyce, Provincial Directornboyce@ohsutp.caCC Sapp, Provincial Trainerccsapp@ohsutp.ca490 Sherbourne St., 2nd FloorToronto, ON M4X 1K91-866-591-0347 (toll free)416-703-7348 (t)www.ohsutp.ca