EDITORIAL: CHOICES, OPTIONS, AND PEER SUPPORT
By Mary Ellen Harrod, NUAA CEO
It may seem trite, obvious, to say that people who use drugs are as diverse as people who drive cars or drink coffee or ride the train but it still needs to be said. Our issues and needs are diverse. We each have our own reasons for using and not using, each of us makes choices and sometimes we need treatment services to support our choices. There is one thing we all do have in common - the need for respect, support and community.
The way to ensure that these basic principles are included in treatment is consumer participation and peer support. Consumer participation and peer support are basics for many types of health care but lag behind in drug and alcohol services.
Why? Because there is a prevailing belief in society that drug use is a moral evil. We are told, again and again, that drug users are depraved, degenerates, ice zombies, junkies, pot heads. Treatment models have historically echoed these beliefs with harsh and punitive services. Abstinence has been aggressively marketed as a one-size-fits-all approach, that the answer is “just say no”. Abstinence is often justified through the “disease model” that argues that drug dependence is related to our (depraved) brain circuitry. Many, many millions of dollars have been spent finding the brain circuits responsible for “addiction”. But what happens when and if we find them? What changes? The basics, peer support, person-centred care will still be the most effective way to help people with their choices.
This fundamental view that drugs are a moral evil, the assumption that people who use drugs cannot make their own choices, has limited treatment options and increased harms.
We may internalise this morality and take on the belief that we “should” be abstinent and that when treatment does not work we have failed. We are sometimes shamed by doctors and service providers and when we are, we don’t return. We blame ourselves for our “weakness”, we are ashamed of our using, we use alone, we hide, we die.
When morality is translated into policy, we are stripped of our choice and dignity. It ignores the complexity of drug use. In terms of public policy, it means we die. While the rate of overdose climbs around the world – last year more people died of overdose in the USA than through guns and overdoses in Australia are increasing, the response is muted. Naloxone is hard to get, it’s expensive. There is no public outcry, no legislation requiring naloxone to be distributed with opiate scripts, no change to policy. Because we brought it on ourselves, we fucked up, we died.
We need to change the discourse, and the news is not all bad.
Many people are fighting for choice, for respect and to end the war on people who use drugs. Our allies include families, clinicians, politicians - they are widespread and their voices are becoming louder. Peers and peer support, and consumer engagement, having been written into public policy for years, is being taken up by many services. Treatment services are becoming more respectful and our choices are growing. At NUAA, we are fighting, daily, for peer expertise to be recognised and for consumers to have a voice in their health care.
This edition describes a number of treatment services and options, from resi rehab to harm reduction. There is no one-size-fits-all model that is going to work. The health and wellbeing of all users is important, and everyone should be supported at all stages of their lives, in all modes of using or not using. We need to keep all options open and remember that only by maintaining choices will we be able ensure the health and well-being of our community