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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Understanding Drug-Related Stigma
- 1. 1 Understanding Drug-Related Stigma Tools for Better Practice & Social Change Emily Winkelstein, MSW Harm Reduction Coalition
- 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 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 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 Curriculum Approach: Increase Cultural Competency Make concepts tangible Translate knowledge -> Practice Create safety for introspection & self-assessment
- 6. 6 Curriculum Development Lecture/Interactive Discussion Personal Relevance Activities • Independent and Group Multi-media • Video Emphasize flexibility
- 7. 7 Approach: Tangible Concepts What is stigma? Forms of stigma Functions of stigma Key elements of drug-related stigma
- 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 Approach: Introspection & self-assessment Values Clarification tool Embrace “messiness” Encourage discussion beyond “professional” experience Emphasis on “subtle implications”
- 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 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 Emily Winkelstein, MSW winkelstein@harmreduction.org 212-213-6376 x43 Harm Reduction Coalition 22 West 27th Street, 5th Floor New York, NY 10001
Notes de l'éditeur
- 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