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1 March 2010 |
drinkanddrugsnews
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Infamy, infamy
The dictionary definition of stigma is 'a
mark of disgrace or infamy; a stain or
reproach, as on one's reputation’ and in
sociological theory a stigma is ‘an
attribute, behaviour, or reputation which is
socially discrediting in a particular way: it
causes an individual to be mentally classi-
fied by others in an undesirable, rejected
stereotype rather than in an accepted,
normal one’ – so how can stigma ever be
good as suggested by Neil McKeganey in
his opinion piece (
DDN
, 15 February page
14)?
The idea that stigma can be used to
benefit public health defies belief and we
would like to see the evidence for stigma
as a useful tool in public health policy. We
would also like to see the evidence that
says heroin is used less because the level
of stigma on its use is greater.
We also disagree with the idea that ‘the
behaviour’
ie
the use of drugs in society can
be used as a social barrier and separated
from the person, or that stigma can be used
to bring about behavioural change. In
Uganda the stigma of homosexuality is
being used to threaten people who engage
in same-sex acts with imprisonment and
death (in the Anti-Homosexuality Bill of
2009). In fact if you altered McKeganey’s
article to refer to homosexuality and
homosexuals instead of drug use and drug
users, the article would not have been
allowed under law in the UK.
The risk of printing such an opinion-
ated and distorted view is that people get
drawn into these destructive arguments,
but it would be unthinkable to let Prof
McKeganey’s views go unchallenged.
Dr Chris Ford, clinical director, SMMGP;
Dr Robert Newman, Beth Israel Medical Center
(NY); Elsa Browne, SMMGP project manager; Dr
George Ryan, GPwSI/shared care GP in
Wolverhampton; Dr Steve Brinksman, RCGP
regional drugs lead; Dr Susi Harris GP, addiction
specialist, Calderdale; Beryl Poole, Alliance; Dr
Garrett McGovern, GP specialising in substance
use, Dublin; Danny Morris, independent trainer
and consultant; Niamh Eastwood, deputy
director and head of legal services, Release;
Stephen Heller-Murphy, addiction policy
development, Scottish Prison Service; Brian
Whitehead, director of SHOC; Des Flannagan,
addiction service manager, Northern Ireland;
Nigel Brunsdon, trainer; Dr Albrecht Ulmer,
German Society for Addiction Medicine,
Stuttgart; Dr Roy Robertson, reader, University
of Edinburgh; Dr Euan Lawson, GPSI substance
misuse; Dr Stefan Janikiewicz; Kate Halliday,
development and policy manager, SMMGP; Dr
Nat Wright, RCGP; David Young, addiction
specialist; Gary Sutton, head of drugs services,
Release; Claire Robbins, specialist nurse.
As I hope most readers will recognise, DDN
is fully committed to challenging stigma
towards everyone involved with substance
use, whatever the context, and whole-
heartedly refutes any suggestion to the
contrary. We are also dedicated to providing
a fair and independent forum for comment
and have no wish to discourage anyone
from submitting a reasoned argument for
debate. This is extremely important to our
editorial integrity and in no way suggests
that we agree or disagree with the content
of our articles.
Claire Brown, editor
Judgement day
Just in case there happens to be an
avalanche of disapproval regarding Neil
McKeganey’s well-argued piece on stigma
(
DDN
, 15 February, page 14) can I just say
I think he makes some valid – and in our
field, infrequently heard – points.
Stigma is not bad by definition, as he
illustrates with the drink-driving example. It
sometimes seems that we go so far to
avoid being ‘judgemental’ in treatment
that we risk a disastrous end result. You
can scream
Daily Mail
! at me if you like. I
happen to despise the
Daily Mail
, but just
because I find it reprehensible doesn’t
mean it’s always wrong.
The ‘war on drugs’ is a horrible mess, as
we all know, but the end result of that
horrible mess is that if you buy heroin or
cocaine you are subsidising a bottomless pit
of misery and exploitation, from desperate
drug mules, to the corpses piling up in
Mexico, to the bombs of the Taliban. A bit of
stigmatisation doesn’t go amiss – taking
heroin or cocaine is an utterly selfish act.
Which brings me on to another well-
worn theme in our field. I think some form
‘The idea that stigma can be used to benefit
public health defies belief and we would like to see
the evidence for stigma as a useful tool in public
health policy. We would also like to see the
evidence that says heroin is used less because
the level of stigma on its use is greater.’
of decriminalisation is inevitable in the
long term, and no sensible person
believes someone should be jailed for
possession of drugs for personal use. But
I’ve yet to see a genuinely convincing
model of a post-prohibition utopia. There
are one or two sizeable elephants in the
room, it seems to me.
The cost of a gram of cocaine is – as
we’re often told – something like £2 at
source, with the £48 mark-up going into the
pockets of various undesirables on its
journey from South America to the streets
of the UK. So far, so bad. But what happens
when we’ve removed the gangsters from
the equation? Does that £48 go into the
pockets of big pharma companies licensed
to sell the drug, or into the pockets of HM
Treasury to fund ‘education and prevention’
programmes? Or do we sell it for a fiver a
gram, along with heroin and thereby
miraculously eliminate all acquisitive crime
in one fell swoop? What kind of public
health impacts do people really think there
would be if you could legally buy these
drugs in a pharmacy or, God forbid, a bar? I
don’t accept the ‘short-term spike in use
followed by a long decline’ model at all, and
I don’t see how anyone else can.
And what do all these gangsters do
when you take their billions in drug profits off
them? The border city of Cuidad Juarez in
Mexico is on the frontline of the war on
drugs, a place where drug-related killings are
a matter of pretty much daily occurrence.
Somewhat less frequently reported,
however, are the thousands of women and
children that have disappeared from the
town since the early ’90s to be trafficked
north to the US, with the raped and
mutilated bodies of those that didn’t make it
that far dumped on local waste ground.
That
’
s
what these people will be doing
instead of the drug trade. Or maybe I’m
wrong. Maybe they’ll get a job in their
local library or go and do some voluntary
work instead.
Molly Cochrane, by email
Support the workers
Since we began 18 months ago, we have
been very conscious of the specific issues
that workers in the substance misuse sector
face if they have histories of problematic
drug or alcohol use (for example – stigma
from staff and management, glass ceilings,
pressure from clients to break boundaries,
outing from bumping into clients at self-help
groups, anxieties about getting qualified
after a poor educational history, risk [or
suspicion of risk] of relapse, having to work
with clients that used to be peers or
partners – to name just a few).
We all (staff and trustees) have
histories of using or being affected by
substances and currently work in this
sector, so we have direct experience.
That’s why in July of last year we began
to provide a support group for workers in
this situation. It is free and we offer it on
the last Sunday of every month at 5.00pm
– 6.30pm at our training room in Bethnal
Green, London.
You can e-mail for more information
and a map – l.bush@inspirit-training.org.uk
Linda Bush, director, learning and
development, Inspirit, London
Spirited argument
I found your article
Facing the Spirits
(
DDN
15 February, page 6) interesting and
thought provoking – however it’s left me
with a bad taste, with your avoidance of
the evangelical church and their use of
prayer and exorcism. I know of residential
and other services over the years who
have used exorcism or intense prayer on
people who were suffering withdrawals,
hearing voices and having hallucinations.
While having no direct experience I have
heard plenty of anecdotal accounts.
Your focusing on the fringe religions
and groups, as well as the easily targeted
muslim fundamentalists, without any
mention of the Christian fundamentalists
make me wonder about the sensationalist
nature of the article.
Stewart Dickson, Aberdeenshire
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