WILL DRUG USERS RESPOND TO THE CHALLENGE?

by Peter McDermott

Just a few years ago, most drug services tried to discourage their clients from hanging around with each other. Over the last year or so, that has started to change. Agencies have stopped being antagonistic to the junkie lifestyle, and have started to embrace it, attempting to encourage the formation of 'drug user organisations'. What on earth is going on?

To understand the current enthusiasm for drug user self-help groups, you have to recognise the dramatic change in the drugs field since the advent of HIV and AIDS. During the 1980's, a smaller and smaller fraction of drug users thought visiting drug agencies worth the bus fare. Maintenance prescribing had gone out of fashion; all most services offered was counselling for those few people who wanted to stop using drugs. As a result, agencies saw a tiny minority of hardcore drug users. That suited the staff, who wanted to do in-depth work with a small number of committed clients.

AIDS changed all that. While heroin might kill you, AIDS undoubtedly would - and the 'you' could include non-drug users who had sex with drug users or their children. With middle England's welfare at risk, it suddenly became a priority to persuade drug users to change to less risky forms of behaviour.

Before drug services could persuade drug users to change, they first had to establish a dialogue with them. The problem was that most drug agencies lacked credibility with active users, who tended to see counselling as irrelevant to their needs; the solution had been conceived by a Dutch drug user organisation called the 'Junkiebond'.

Loosely translated as 'addicts' union', the Rotterdam Junkiebond was set up by a couple of active addicts who were tired of the treatment they got and wanted to do something about it. They lobbied politicians and the media to present an accurate picture of the lives of drug users and to gain a voice in policy making. Faced with an outbreak of Hepatitis B, in 1982 they distributed clean needles and syringes to combat the virus - and the first needle exchange was born.

After some resistance, in Britain needle exchange now enjoys almost unanimous acceptance. At the same time there were calls for more 'flexible' prescribing - a euphemism for a return to long-term maintenance. Along with outreach, these new 'user friendly' approaches turned the situation around, attracting many drug users into contact with drug services and averting the AIDS disaster that hit injectors in the USA, Italy and Spain. The proof of the pudding was what happened where pockets of resistance remained, such as Edinburgh.

Nevertheless, most injectors remained out of contact with drug services - and some who were in contact continued to put themselves and others at risk of HIV and AIDS. It seemed we had run up against the limits of what can be achieved with conventional services, where 'professional' workers deliver a service to users, whose role is simply to receive the service.

For some researchers a more active role for drug users was the way forward. In one way drug users and ex-users had been active for years.

Many ex-users have 'crossed over' and become drug workers and some have reached very senior positions in Britain's largest drug services. There may be many more who are current users but (wisely) not owning up to it.

Something different seemed needed - the involvement of current drug users still active in drug using networks. Researchers argued that the best way to exert influence on drug users not in touch with services was to encourage drug user networks and self-help groups to educate their own communities. If they won't come to our services, let's make them the service instead, was the theory. It was one that gained the blessing of the government's advisers, the Advisory Council on the Misuse of Drugs, in a report published in 1993.

The model they proposed is just one sort of drug user group. Existing models span the anonymity of Narcotics Anonymous to the activism of Dutch drug users' 'unions'. Each of the models poses some serious problems for potential members. To stand any chance of success, a user organisation will probably need to incorporate aspects from several of the models in the panel. But perhaps the biggest problem is mobilising support among active drug users. Drug use is illegal, and drug users are highly stigmatised. Those most likely to have the skills needed by a user group are also the ones most likely to be employed. They have a lot to lose if they are fingered as active users - even if they are stabilised on methadone.

I can personally assure you that no matter how stable you are, or how useful your activism is, once you are 'outed' you will experience serious discrimination that can be very difficult to overcome. What this means is that often those most willing to get involved also lack the kind of skills a drug user organisation needs.

The second problem is that of how representative the group can be, and how it makes its decisions. Drug users are an extremely diverse population with a wide range of attitudes towards their problems.

Reflecting all these can be very difficult. Many groups rely on a single committed individual who struggles to keep everything going but, due to the surrounding apathy, is unable to claim to represent the local user community.

Which leads to the third problem: who should be allowed to join? There are advantages in wide membership. Professionals in the drugs field can bring credibility, resources and badly needed skills; ex-users can bring experience of recovery and add stability to the group.

But these groups have their own agendas that often conflict with those of active users. To safeguard their own sobriety, ex-users may have to distance themselves from current users. Drug workers are unlikely to feel happy making certain sorely needed criticisms of drug agencies. Some workers are totally unacceptable because of their attitudes to the issues. How would an organisation stop such a worker gaining a position of power that enabled him or her to exercise undue control over the group? On balance, where possible it is probably best to work with professionals, but groups need to carefully define how such alliances will be made.

The biggest challenge drug user groups face is overcoming feelings of impotence, inertia and apathy among potential members. Many won't get involved because they think it's a waste of time - that drug users have no power and that groups will find it impossible to bring about change.

Yet that isn't the case. Recently, government said all areas must consult service users when planning their drugs strategy. Overseas, drug user groups are growing rapidly. Even the USA, home of the 'War on Drugs', has organisations like Methadone Awareness and the National Association of Methadone Advocates, and some methadone clinics employ maintained users as staff counsellors. Drug user self-help organisations can also play a vital role in the UK. They can tackle the stigma of addiction and methadone maintenance, so treatment services and government get a more accurate picture of the lives of drug users. By helping themselves and others, drug users can regain some meaning and sense of personal worth in their lives. For too long, people have painted an inaccurate picture of drugs and drug users; for too long, drug users have been stigmatised and marginalised. Drug user self-help groups provide users, government and workers an opportunity to work together on a common therapeutic agenda.

The question is - if the British state can bury its prejudices and commit to working with active drug users, will British drug users respond to the challenge?

Peter McDermott is a writer and researcher. This article first appeared in Juice magazine.