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View Diary: Sin, stigma and syringes: The struggle for harm reduction (109 comments)

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  •  An excellent, thought provoking piece, as always (20+ / 0-)

    Ms. Dee. You've really sent me back to the drawing board to examine one of my fundamental beliefs.

    When I read the title the words harm reduction caused a visceral reaction in me. Not a pleasant one, either. For me, and the populations I work with (veterans, homeless, homeless veterans) harm reduction usually means substituting a licit substance for an illicit one.

    Put another way, shifting the profit margin from the underground economy to Big Pharma. The "client" is no better off psychologically, emotionally. or spiritually, and sometimes even physically. But some licensed professional gets to check off another box on the path to career advancement. (A tad bitter, ain't I)

    When you present harm reduction as needle exchanges, however, you have my unmitigated support. I'm going to have to rethink my knee-jerk opposition to the label.

    “Perhaps the most 'spiritual' thing any of us can do is simply to look through our own eyes, see with eyes of wholeness, and act with integrity and kindness.” Jon Kabat-Zinn

    by DaNang65 on Sun Jan 27, 2013 at 04:17:19 PM PST

    •  I have the same reaction you do to the (18+ / 0-)

      illict to licit move.  Will address that in a future piece - I have some major problems with methadone maintenance, but it requires more than just a paragraph to explain.

      Join us on the Black Kos front porch to review news and views written from a black pov—everyone is welcome.

      by Denise Oliver Velez on Sun Jan 27, 2013 at 04:21:08 PM PST

      [ Parent ]

    •  THIS. (11+ / 0-)

      This is one of the [many] reasons I have such a problem with the AA/12-step approach.  I know that it works for some people (or at least they think it does), and if it works for you, hey - I'm happy for you.

      But for too many, and I see this in our communities on what is sadly a daily basis, it does not work:  It merely substitutes one societally-approved addiction for another.  And I hate it.

      Wings has been sober for a quarter-century now.  he went through a traditional program for Indians, precisely because AA didn't work.  Based on contradictory premises; Xtianist and a dominant-culture approach through and through.  An utter failure for him and countless others like him.  But now?  If he wants to have a glass of wine, he can do so, with no dependency issues, and no fear.  And it's because of the difference in approach, which is manifestly NOT to substitute a licit substance for an illicit one.

      Now, I need to be really, really clear here, lest people think that running out to the nearest fraudulent "shaman" peddling faux-NDN spirituality will work.  This has nothing to do with NDN spirituality, nor with any of our secret traditions that people might somehow think are being illegitimately withheld from those in need.  They're not, BTW:  If you're not born into that tradition, nothing about it will help you, per se.  What it is is a worldview that approaches addiction (like everything else) in a way entirely different from the dominant culture:  One that does not begin and end with an irreducible insistence on some form of dependence, on the "once an addict, always an addict" mantra that locks people into other, socially acceptable and societally sanctioned dependencies.

      And this is why, Nij, I tell you that you're wise.

      Authentic Native American silverwork, jewelry, photography, and other art here.

      by Aji on Sun Jan 27, 2013 at 05:44:15 PM PST

      [ Parent ]

      •  yes. One of the problems with (9+ / 0-)

        a strictly 12 step approach is the ties to Christianity and as you so clearly put it "dominant-culture".  The other problem is judgmentalism - only if you are clean and sober are you okay.

        Nad and I have had many arguments with our AA/NA brethren  about those attitudes.

         

        Join us on the Black Kos front porch to review news and views written from a black pov—everyone is welcome.

        by Denise Oliver Velez on Sun Jan 27, 2013 at 06:04:48 PM PST

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        •  Yes. (6+ / 0-)

          I've never understood how something can work when it proceeds from utterly inconsistent premises:

          1)  You're entirely responsible for your own behavior; and yet

          2) You control nothing; God controls everything.

          And then you get into the whole focus on sin/punishment/redemption dynamic, which leaves no room for an individual to grow, evolve, change.  And - at least in some cases, because I've seen it too many times in our cultures - it can be done.  And all I see around me are the ruins of lives of those forced (usually by the courts) into Xtianist 12-step programs.  [Sigh] had a reminder about that last night, and another this morning.

          Authentic Native American silverwork, jewelry, photography, and other art here.

          by Aji on Sun Jan 27, 2013 at 06:22:29 PM PST

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          •  True, you don't understand. (3+ / 0-)

            The 12 steps as originally developed were a program of complete dependence upon God (or some Higher Power.)  The basic idea is that if you can help yourself, you're not an addict - you're a person with a drug problem, or a drink problem, or whatever.  The addict is somebody who finds themselves faced with certain death if they don't experience an authentic miracle.

            But people hate that message of spiritual helplessness, and keep finding ways to change it into a program of willpower or morality or psychotherapy.  The big book of AA - which was the original 12 steps - states explicitly that it's not a question of willpower, and if it was we would already be cured.  But not too many people read that book any more.  After 80 years, it's still startlingly radical.

            Early to rise and early to bed Makes a man healthy, wealthy, and dead. --Not Benjamin Franklin

            by Boundegar on Sun Jan 27, 2013 at 06:58:27 PM PST

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      •  I'm not sure how AA got into this discussion. (2+ / 0-)
        Recommended by:
        Denise Oliver Velez, sfbob

        And I'm unclear about what "societally-approved addiction" AA promotes.

        Twelve step programs work for many people - principally, in my personal experience, those who can open their ears and minds and understand that they cannot control everything in their lives. AA talks a lot about a higher power and it's true that for Bill W., Dr, Bob, and lots of others, that meant the god of the bible. But for many others, the search for a higher power that has meaning for them eventually takes them to much different spiritual places than the church on the corner.

        AA offers structure, support, and fellowship to people who need some or all those things. There is nothing addictive about it.

        I don't know who Wings is; I'm glad he's 25 years sober. He's a lucky guy if he can have the occasional glass of wine without deleterious effect. I can't. For me, one glass leads to a whole bottle.  AA helps me to remember that when my head tells me I'm like Wings and can drink the wine.

        The NRA is a terrorist organization.

        by one you can live with on Sun Jan 27, 2013 at 06:19:13 PM PST

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        •  Perhaps you need to step back and take . . . (4+ / 0-)

          my comment a bit more neutrally.  I said VERY clearly, "if it works for you, hey, I'm happy for you."

          I clearly talk about our indigenous approaches.  There is great merit into getting Xtianist anything out of our treatment of addictions in our societies.  And it manifestly does NOT work in our cultures, not for any relatives, not for any friends, not for any acquaintances that I've ever seen.  but non-12-step programs that completely jettison the so-called "conventional wisdom" surrounding the dominant culture approach to addiction in all its forms.  And every single person I've ever known bar absolutely NONE, who has gone the 12-step route has merely substituted a dependency on the 12-step program itself (or on certain ancillary shibboleths peddled by those who operate at the fringes of 12-step programs in an effort to feed off them) for whatever substance addiction they had.

          It works for you?  Great.  Do not for a moment assume that it works cross-culturally, or even within cultures for everyone who happens to be a member.

          And since Dee (and probably everyone else here is clear), I feel no need to respond to that cheap shot about "who Wings is."

          Authentic Native American silverwork, jewelry, photography, and other art here.

          by Aji on Sun Jan 27, 2013 at 06:27:29 PM PST

          [ Parent ]

        •  You don't understand (7+ / 0-)

          this is not an attack on AA or any 12 step programs - if it works for many fine.  I've been clean/sober for 30 years - I've also seen the program(s) not work for many - and seen those people judged. I also remember clearly - AA 's judging "addicts", NA's telling people they couldn't talk about being HIV because it was "an outside issue" - there was a streak of puritanism that was to me - unacceptable.

          Aji is speaking from her experience and her cultural perspective.

          The only thing that is important is what works.  Harm reduction works , for some people.  My dear friends in NA do not approve of my willingness to support medically prescribed heroin.  Not everyone can or should have to follow a 12 step path.  In NA people are told that they only have 2 choices - the NA way or "jails institutions and death".  I feel that there is a third path - no one should be imprisoned or institutionalized for using substances.  Period.

          Death will come to us all.  

          Join us on the Black Kos front porch to review news and views written from a black pov—everyone is welcome.

          by Denise Oliver Velez on Sun Jan 27, 2013 at 07:40:22 PM PST

          [ Parent ]

          •  It's worth remembering that (2+ / 0-)
            Recommended by:
            bsmechanic, spacecadet1

            the primary reason that 12-step group approaches so dominate the substance-abuse treatment industry is that they don't require highly educated professional counselors; programs can be staffed with $12/hr high school graduates. It has nothing to do with effectiveness. Research shows that the 12-step approach definitely works for some people, but they're a minority (it seems to work best for people who have dependent personalities and who aren't highly educated).

            Note that the argument that 12-step programs work for anyone who tries hard enough to follow them is a non-falsifiable one: if you believe it, then every possible set of observations is consistent with it. Heads I win, tails you lose. Note also that most "ex-gay" programs are based on a similar argument.

            Writing in all lower-case letters should be a capital offense

            by ebohlman on Mon Jan 28, 2013 at 01:12:01 AM PST

            [ Parent ]

      •  You do me too much honor, Nij. (3+ / 0-)
        Recommended by:
        Aji, mapamp, Denise Oliver Velez

        I didn't know that about Wings, but am not at all surprised. On my journey I was privileged to sit with a genuine Native American healer, Curtis Kekahbah, in a three day seminar.

         photo Curtis_zps830dfa2c.jpgCurtis is a rather unusual man. About my age, I imagine he struggled with his own demons before he trained at the VA for nine years in western psychiatry to become a Substance Abuse Counselor. He also trained with what he calls "the medicine people."

        He cannot speak too highly of his VA mentor, but "the medicine people were really tough" he says.

        These days, his health and the VA's travel budget permitting, he shuttles between VAs in Tucson, Kansas, and South Dakota bringing his unique blend of traditional healing, western science, and vast experience to veterans trying to shake off their addictions.

        Curiously, more than a few who've just found Jeebus through AA get up and walk out on Curtis as soon as they realize he's not about 12 Steps. Their loss.

        For those who stay there's what I would call a guided meditation, others might think it's a vision quest, that is one of the most powerful things I've ever done. The gift we give ourselves is our selves.

        “Perhaps the most 'spiritual' thing any of us can do is simply to look through our own eyes, see with eyes of wholeness, and act with integrity and kindness.” Jon Kabat-Zinn

        by DaNang65 on Sun Jan 27, 2013 at 06:25:27 PM PST

        [ Parent ]

        •  LOL - why am I not surprised? (3+ / 0-)
          Recommended by:
          DaNang65, mapamp, Denise Oliver Velez

          I've fought that particular mindset forever, it seems, in my own family and among friends and acquaintances.  As you say, "their loss."

          There is so much more to what's possible than the narrow worldview presented in that archetype.  But it's what this society "approves."  So, as with so much in medicine, health care, social policy, and everything else political in this country, whether it actually works is at best secondary - more likely, utterly irrelevant.

          Authentic Native American silverwork, jewelry, photography, and other art here.

          by Aji on Sun Jan 27, 2013 at 06:33:32 PM PST

          [ Parent ]

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