dr. oliver aldridge edinburgh, midlothian & east lothian dtto i and dtto ii
TRANSCRIPT
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Dr. Oliver AldridgeEdinburgh, Midlothian & East Lothian DTTO I and DTTO II
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Theory
Client
Communication
Agency
Conclusions
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Ancient Greeks physically scarred people to permanently “mark” them
Today: amputation of a finger to denote someone who is deemed to be a “grass”
May be part of the survival mechanism of group living
Some of the original driving force behind drugs legislation – San Francisco 1865
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Reciprocity Threat: housing, benefits,
treatment/support, theft, “infecting others” by introducing to drugs.
Downward comparison Belief in a “Just” world/ “Protestant Work
Ethic” – you get what you deserve and you deserve what you get
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Drug users are bad parents Drug users are dishonest Drug users are manipulative Drug users are self-indulgent Drug users are wasters Drug users destroy communities Drug users choose to be drug users
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Stereotyping facilitates stigmatisation
Stigmatisation encourages stereotyping
May be linked to depersonalisation
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Needs to be openly discussed so that it can be managed on an individual level.
Differing levels of stigma sensitivity between clients
Cannot make automatic assumptions about the effect on a client
Cannot make automatic assumptions about the main sources of stigma
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Usually drug use is only one factor: Poverty Poor education Unemployment Criminal record Drug taking Injecting Parenting
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Difficult childhood Learning difficulties May contribute to feeling excluded Social acceptance may be sought in a
marginalised peer group As part of that group, drug
taking/experimenting may be the norm Effect of criminalising groups?
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Physical Signs
Treatment Stigmata
Social Stigmata
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Visible signs of drug use include:Injection sitesPoor dentitionPoor nutritionAppearing intoxicated/withdrawn
Managing these appropriately may increase the range of options in managing stigma
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You’ve got to know when to hold ‘em…..Know when to fold ‘em…..
Managing disclosure is a highly individual, situation specific problem
If stigma is not overtly discussed, it is not possible to devise an effective, individualised strategy to deal with it
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Exposure of a previously, largely hidden level of drug use
Loss of employment Peer group rejection Relationship breakdown Increased intervention e.g. Children &
Families Labelling Disempowerment Social Isolation
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Local vs. Centralised treatment services – pros and cons
Failing to treat people holistically Perpetuating or increasing stigma in the
treatment environment Recovery = Abstinence Information sharing vs. “raw data” being
communicated to people without specialist knowledge
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Some treatment options may feel less stigmatising to the client e.g. DHC vs. Methadone
Treatment needs to have a solid evidence base and be effective and appropriate for the client at that time
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May be stigmatising
Alterations to pharmacy may impact positively
May reduce stigma
Effect is individual and, therefore, policy should allow individual assessment/decision making
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Method – supervised urine collection processes
Rationale – is it being done to “catch” people?
What is the context of a result?
May help to combat negative attitudes
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Wraparound care essential Helping people integrate into new social
groups The role of “ex-user” does not work for
everyone
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As specialist agencies we have a responsibility to provide good quality, objective information to:
Communities Media Government Professionals Students
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Views/hypotheses may impact on stigmatisation
Is it better to be viewed as someone with a genetically determined problem or as someone with a social problem?
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Facilitating appropriate contact with people who don’t conform to stereotypical views may catalyse change
Caveat: Stigmatisation may paradoxically be increased by contact with someone who is massively different to the stereotypical view
Does the “exception” prove the “rule”?
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May be stigmatised by the communities in which it works – “NIMBYism”
Workers may need support – e.g. outreach, needle exchange workers
Related professionals/disciplines may stigmatise those who work in this field
We may stigmatise each other by perpetuating false debates e.g. Harm Reduction vs. Abstinence
Funding wars may increase stigmatisation by threatening survival
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Stigma is here to stay – we have to learn to manage it effectively
Management of stigma has to be individualised
Stigma cannot be dealt with if it’s not openly addressed
Treatment can contribute to stigmatisation: agencies need to consider this in service planning/delivery
Commissioning needs to look at the range of treatment services available to increase choice
Agencies have to play a positive role in educating/communicating