1
Understanding
Drug-Related Stigma
Tools for Better Practice
& Social Change
Emily Winkelstein, MSW
Harm Reduction Coalit...
2
So…Why stigma? Why now?
 How we do the work needs to be as
important as meeting deliverables
 Stigma has been largely ...
3
So…Why stigma? Why now?
 Shifts in the political & funding
landscapes
 Stigma is a root cause of:
• Unhealthy
communit...
4
Project Overview
 Funding from NYS DOH AIDS Institute
 3-hour training curriculum
• PP, Facilitator’s Guide, Participa...
5
Curriculum Approach:
Increase Cultural Competency
 Make concepts tangible
 Translate knowledge -> Practice
 Create sa...
6
Curriculum Development
 Lecture/Interactive Discussion
 Personal Relevance
 Activities
• Independent and Group
 Mult...
7
Approach: Tangible Concepts
 What is stigma?
 Forms of stigma
 Functions of stigma
 Key elements of drug-related
sti...
8
Approach: Knowledge  Practice
 Implications for Providers
 Group analysis & strategy-building
• Stigmatizer and Stigm...
9
Approach:
Introspection & self-assessment
 Values Clarification tool
 Embrace “messiness”
 Encourage discussion beyon...
10
Lessons-Learned: Content
 Stigma vs. prejudice vs. discrimination
 Struggle with embracing some key HR
concepts:
• Dr...
11
A few more lessons learned...
 Few outlets to really explore stigma
 Takes time & commitment
 It’s difficult & almos...
12
Emily Winkelstein, MSW
winkelstein@harmreduction.org
212-213-6376 x43
Harm Reduction Coalition
22 West 27th Street, 5th...
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Understanding Drug-Related Stigma

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A presentation at the 8th National Harm Reduction Conference in Austin, TX November 18-21, 2010.

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  • How we do the work needs to be as important as meeting deliverables
    it’s easy to get caught up in the day-to-day of keeping programs running - but how the work is done matters - and requires attention.
    not as simple as “if you build it, they will come” - stigma=trauma and people will do what they need to do to avoid being traumatized
    We are the “good” guys - what does it say if we do not confront and challenge stigma? It reinforces the same negative experiences that people have had and perpetuates internalized shame which has real consequence on outcomes.
    It comes up in pretty much every single training that HRC does - became clear that we couldn’t take the impact of stigma for granted, and that we needed to devote some very pointed attention to it.
    Stigma has been largely normalized
    Someone asked me the other day why stigma was such a big issue for providers...
    It’s because Providers live in the world too and stigma against drug users is so pervasive (whether it is bold discrimination or subtle patronizing attitudes)
    And it’s complicated...because the work is hard - sometimes we see shit that is frustrating, or hard, or terrible, and it’s easy to fall into the trap...
  • Shifts in the political and funding landscape
    HR, in some ways (sometimes in name only) is becoming more widespread
    Of course, HR is more than a single worker in a sea of non-HR workers..but...
    Part of what makes HR what it is, is that it is rooted in a rich history of social justice, community, and respect for drug users.
    We want HR to take off - and we want it to be a broad and diverse movement - AND, all the more reason to focus on stigma now - give people an outlet to explore some of these tricky, sometimes very personal issues
    Stigma is a root cause of disease, unhealthy communities/relationships and death
    Seems a bit dramatic...but it’s very real - ex: internalized stigma, support networks, use behaviors and patterns, willingness to seek treatment and help, willingness to talk openly and honestly - all shaped by stigma. OD, HIV, HCV, etc...
    Stigma more damaging than drugs or other behaviors
  • Tangible overview
    What is stigma…why is it important?
    Knowledge  Practice
    Increase cultural competency
    Provide tools/strategies
    Introspective
    How do we perpetuate drug-related stigma?
    GOALS
    Identify and explore the reach of drug-related stigma.
    Name strategies for confronting drug-related stigma.
    Promote productive service provision that avoids stigmatizing people who use drugs.
  • Lecture/Interactive Discussion
    Present some basic information...framework for thinking about the issue...
    Think about stigma from a drug-related and non-drug related perspective
    create a space for people to explore the issues...find personal relevance Personal Relevance
    Define concepts...
    Activities
    Independent and Group
    Quote exercise
    Round-robin
    Small groups
    Multi-media
    Video - whitney!
    Trying to find an exercise that revealed the many layers that wasn’t at the same time stigmatizing.
    Emphasize flexibility
    trainer flexibility - bring self and own experience to the training
    Offer examples, encourage trainers to adapt as needed
    Use teachable moments...some trainings become much more about discussion...some the activities are the key.
  • Provide a different insight...shift perspective..so, it may not always be what is the client doing wrong...but, what is my role, how can i make the service more appealing.
    Analyze some of the ways we perpetuate stigma in a way that is removed, but still relevant - applying the institutional lens
    Wanted to provide steps that people could take at different levels of the process...
    - so, for some, they may be able to challenge non-traditional service boundaries..work at the relationship level
    - for other, may be about getting more education, for others, language assessment or getting involved in community advocacy
  • It’s not about answers
    Relationships, language and labels
  • This is a beginning...
    Individual - Agency - Community levels
    HR & STIGMA
    Accepts that stigma is a part of the world
    There are ways to manage & challenge stigma
    Stigma intersects with other forms of marginalization & oppression
    When challenging stigma, meet all people where they’re at
    Acknowledges that change is hard, values incremental change
  • Understanding Drug-Related Stigma

    1. 1. 1 Understanding Drug-Related Stigma Tools for Better Practice & Social Change Emily Winkelstein, MSW Harm Reduction Coalition
    2. 2. 2 So…Why stigma? Why now?  How we do the work needs to be as important as meeting deliverables  Stigma has been largely normalized • (Providers live in the world too)
    3. 3. 3 So…Why stigma? Why now?  Shifts in the political & funding landscapes  Stigma is a root cause of: • Unhealthy communities/relationships • Disease transmission • Death
    4. 4. 4 Project Overview  Funding from NYS DOH AIDS Institute  3-hour training curriculum • PP, Facilitator’s Guide, Participant Workbook  Target Audience: “Non-clinical providers”  So far: 8 trainings throughout NYS
    5. 5. 5 Curriculum Approach: Increase Cultural Competency  Make concepts tangible  Translate knowledge -> Practice  Create safety for introspection & self-assessment
    6. 6. 6 Curriculum Development  Lecture/Interactive Discussion  Personal Relevance  Activities • Independent and Group  Multi-media • Video  Emphasize flexibility
    7. 7. 7 Approach: Tangible Concepts  What is stigma?  Forms of stigma  Functions of stigma  Key elements of drug-related stigma
    8. 8. 8 Approach: Knowledge  Practice  Implications for Providers  Group analysis & strategy-building • Stigmatizer and Stigmatized • Institutional lens  Address change on 3 levels • Individual • Staff • Community
    9. 9. 9 Approach: Introspection & self-assessment  Values Clarification tool  Embrace “messiness”  Encourage discussion beyond “professional” experience  Emphasis on “subtle implications”
    10. 10. 10 Lessons-Learned: Content  Stigma vs. prejudice vs. discrimination  Struggle with embracing some key HR concepts: • Drug use management (“functional” use) • Abstinence-based language  Language is key  Us vs. Them is pervasive
    11. 11. 11 A few more lessons learned...  Few outlets to really explore stigma  Takes time & commitment  It’s difficult & almost always very personal  There are many “baby steps” that can make a big difference.
    12. 12. 12 Emily Winkelstein, MSW winkelstein@harmreduction.org 212-213-6376 x43 Harm Reduction Coalition 22 West 27th Street, 5th Floor New York, NY 10001

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