Judgement

Judgement

Written by and for people with Lived Experience - Port Alberni Community Action Team - Families Helping Families

Today’s Learning Moment – 03 22 21 Issue: Judgement.

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Having worked on the street as a mental health and substance use counsellor for the last 10 years of my career, and collaborated with many community agencies in doing so, I can speak a little to this.

The critical issues in my mind first are community knowledge and attitude toward the most vulnerable,  staffing and the slow and gradual acceptance of harm reduction over the last 10 years.  The drug policy crisis and the pandemic have shed light on the gaps even more.

In 2008 or so, our government agency reigned in all outreach.  Everyone who needed service needed to attend the clinic I worked at.  There were 12-14 clinicians then and I think the number might even be less now if not unchanged.  The reason for this move was overwhelming caseloads.  So the answer then was to essentially exclude the most vulnerable to manage caseloads and attempt to avoid burn out amongst the staff.

I was among a small number of others who broke the rules and by 2010, I was surreptitiously doing outreach during my shifts.  This became acceptable again quite quickly as the need was most obviously there and the outreach was most efficient in providing the building harm reduction services needed to help the vulnerable.

During that time, low barrier housing was being introduced in our community.  There was significant pushback by the community to what was considered "wet housing" facilities to the point of legal proceedings against this type of housing.  The main reason this type of housing was being introduced and built is that the traditional form of abstinence-only housing was not working with the most vulnerable.  Sobriety was always the main criteria for old housing aka recovery housing and that's fine when someone is abstinent.  But zero-tolerance meant that the person was homeless the minute they relapsed.  We all know how common relapse can be.

Of course, it is far more than the homeless who are experiencing troubles with substance use.  But as many of us are aware, and the general public is not, there is a debilitating stigma attached to substance use and mental health.

The main impact of stigma is that people will likely not seek out help for fear of very real and visible judgment from society right down to peers and family.

There is a very real cause to this stigma and resulting judgment that has grown malignant almost from the moment that certain drugs were categorized as illicit.  No one likes a criminal.  Criminals are bad and need to be punished.  So our whole system, really when you think about it, is not broken but working exactly as how it was designed.  To punish people who use drugs.  And the policies that have fueled this belief, and the beliefs that have fueled these policies have come from the bottom up to the top down to the kitchen table and right back up again.  It has been Catch 22, a vicious cycle of judgment based on assumptions and not facts of mental health and substance use.

This brings up the issue of coerced or forced treatment.  This is known as the “medicalization” of people who use drugs as opposed to criminalization.  We know that substance use disorder is indeed partly a medical issue in how it impacts brain functioning. But what we rarely think about is that most Canadians use substances of one sort or another and for various reasons.  And that the majority of Canadians who do use, do not develop the disorder.

Quite simply, what we don’t see is that no one wants to be tagged as sick.  That too is about as stigmatizing as being a criminal.

We overgeneralize that all substance use is a disorder thanks to criminalization.  Really, we overgeneralize that illicit substance use is a disorder or more commonly a disease or a sickness. So we apply a medical pathology to certain drugs and not others.  We find ourselves saying “they need help”.  Well, at a certain stage that may be very accurate.  But as humans, we tend to catastrophize.  We catch our teenager smoking pot and immediately believe they are going to end up dead in a ditch.  While well-intentioned, and understandable under our current belief system, this is dangerous fear-based thinking and can actually lead to that very outcome if we pursue it.  It is this fear-based thinking in many forms that actually eats away at trust in relationships.  No one wants to be bad or sick.

So when a person does start to develop problems with substance use and notices, they tend to ignore or “deny” the problem.  Not because they are evil, or want to hurt anyone, or even because they are in the throes of addiction, but because they don’t want to be labelled as criminal or sick.  Unfortunately, tradition then labels them as “in denial”.

This is how stigma becomes a formidable barrier for people who think they might need a little help, early on, to seek out help.  We as a society and as peers, and as family, are ready to jump all over them because of beliefs that have festered over the last century.

And our children die in front of us while we argue about it with the decision-makers.

So ya, there is a lot to unpack here.  There is plenty we need to do to change the system.  And we need to recognize that we are part of that system.  So we need to be critical of our own beliefs and ensure we are following beliefs and policies that are based on facts.  And we need to be open that these facts evolve over time.  Thus our beliefs need to evolve over time.

When I started almost 33 years ago, I "knew" abstinence-only was the only way.  Now I "know" that abstinence is one strategy in harm reduction, that criminalization has led to the stigma we impose on the vulnerable and especially now, has led to the disastrously unsafe toxic supply of illicit drugs that are killing our loved ones today.

What will I learn about this today?

Author: Ben Goerner
Ben is a retired substance illnesses counsellor. He advocates for people with mental health and substance illness.

Families Helping Families is an initiative of the Port Alberni Community Action Team. We send out “Learning Moment” articles regularly to help folks understand substance illness. Knowledge is vital in understanding the illness of our family members. You may copy, distribute or share our articles as long as you retain the attribution. You can be added to our distribution list by dropping us a note at - albernihelp@gmail.com