Stigma" by Emily Ager, Street Outreach Supporter

							Stigma

By Emily Ager, Street Outreach Supporters

It is sometimes said that Santa Cruz has a permissive attitude toward drugs, and drug
users. In the case of marijuana use, medical or recreational, to some extent this is true.
However, as in the rest of the country, users of drugs like heroin and other opiates,
methamphetamine, crack, and cocaine, and especially those who inject these drugs, have
consistently been characterized by negative stereotypes. The stigma attached to injection
drug use is extremely harsh, and deeply entrenched in our culture. The very real mortal
dangers of overdose and AIDS are intrinsically linked to injection drug use, and the
notion that anyone would voluntarily subject oneself to such risks suggests a deteriorated
morality, something that could be dangerous not only to the individual drug user, but to
the community at large. The shadow of contagious damage permeates the cultural
understanding of and feelings about injection drug users (IDUs), which leads to responses
of fear and revulsion. IDUs do not need additional reminders that they are largely a
reviled group of people, whose presence in our community is unwelcome. In fact, the role
of social stigma as it fuels the cycle of addiction, is profound, and is something we as
community health outreach workers endeavor to counter with compassion, patience, and
a pragmatic approach to troubleshooting the myriad harms associated with injection drug
use.

The unremitting negative pressure of the Junkie stereotype is present in our medical
culture, legal system, and popular media. It is a stereotype that is remarkably pervasive,
in spite of the fairly well-accepted idea that addiction is at least in part a disease.
Common assumptions about IDUs include the notion that all Junkies are selfish, amoral,
aggressive, unstable, crazy liars, thieves, and criminals. This drives a cycle of fear that
perpetuates many of the already problematic features of addictive behavior, such as
isolation, reluctance to access support (treatment, medical care, the emotional support of
loved ones), and a persistent erosion of positive self-image. When a person lacks
confidence, and sees themselves as worthless, their behavior tends to reflect this. And to
an unfortunate extent, when a person "knows" that they are dangerous, worthless,
disgusting, unwelcome, etc, they will tend to treat themselves as such, often exhibiting
"evidence" of the stereotype. As a culture we seem to agree that positive reinforcement is
a highly useful tool in shaping negative behavior into positive behavior, but in the case of
injection drug use, the idea that there is a core evil at work prevents many otherwise
compassionate people from extending any degree of acceptance, patience, or willingness
to help, IDUs in their communities. This is true among people who have IDUs in their
families, as well as those who only recognize their presence in terms of a generalized
criminal element.

The experience of injection drug use is at once intensely, though temporarily, healing,
while concurrently being a profound form of self destruction. For chronic injection drug
users, there is a strange balance struck between two warring internal pressures. The
instinct to survive manifests in the physical response to drug withdrawal, thus the impulse
to heal, or self-medicate. This is counterbalanced by the emotional impulse to punish
oneself for being weak, flawed, evil, damaged, rotten to the core. Feelings of self-
loathing, hopelessness, and deep pain were likely already factors that influenced an
individual's drug use. Coupled with stigma, the sense of rejection by one's own
community can easily extinguish initial surges of motivation to improve one's life.

The experience of physical and emotional degradation must be recognized as distinct
from a desire to "get high," which typically is present at the earliest stage of addiction.
Differentiating between emotional triggers that motivate an individual to start using in the
first place, and to continue using in spite of the profound negative impact of addiction,
and the response to cease the intolerable experience of withdrawal, is important when
working with an individual to unravel their particular patterns of drug use. It is also
central to developing a general understanding of addiction in terms of being able to parse
the various impediments to change. One's sense of self-worth is the greatest element in
the foundation for all positive changes in one's life. As harm reduction counselors and
community health outreach workers, it is our job to connect with IDUs, and to find ways
to encourage and instill self-worth. Delivering health education, distributing safer
injecting supplies and exchanging syringes in an atmosphere of mutual respect and trust
allows those basic activities to become tools for effectively undoing the barriers built by
stigma. We endeavor to offer our participants genuine compassion and respect, we
believe that they are inherently valuable as human beings, and deserve the support
required to make difficult changes to improve their health and their lives. The more a
person believes they are worthy and deserving of kindness and respect, the more likely
they are to offer that to themselves, which is prerequisite to any significant and lasting
behavioral change.

It is a cornerstone of the Harm Reduction movement to acknowledge that injection drug
users are human beings, innately deserving of compassion, support, respect, and care.
However, the broader cultural perceptions about injection drug use involve so much
horror, that most people do not find it emotionally comfortable to consider the IDUs in
their own communities as fellow human beings, individuals with families and other
people who they love and who love them, people with whole complex lives that often
include the experience and the potential to be contributing members of society. It is easy
to demonize IDUs and allow those negative stereotypes to justify the wish to simply
remove them from one's community, either through long-term incarceration, forceful
return to their original home (so long as that home is out-of-town), or the harsh belief that
it is inevitable they suffer one of the fatal dangers of their risky behavior, such as
overdose or AIDS. However, this is unrealistic in terms of actual, pragmatic problem-
solving, on either an individual or community level.

As a Harm Reduction-based organization, we are strongly committed to working closely
with the IDUs of Santa Cruz county, offering a space to be honest about the struggles,
challenges, and needs they face. It is the core of our work to offer compassionate support
to find practical solutions to the plethora of troubles common in the lives of chronic drug
users. As with any therapeutic counseling efforts, we work to assist in the rebuilding of
individuals' sense of self-worth. Feeding off the intrinsic impulse to heal and survive, we
recognize the opportunity to support the improvement of self-esteem. This happens
slowly, and in small advances, but progress is possible, and we absolutely see people who
are able to make extraordinary changes in their lives. But every step of the way we are
battling the impact of anti-Junkie stigma, which does not serve to educate, heal, or in fact
to eliminate drug use, drug users, or any of the public health and public safety issues
associated with them.