Results of a participatory needs assessment demonstrate an opportunity to involve people who use alcohol in drug user activism and harm reduction (original) (raw)
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Making voices heard: access to health and social services for substance users
2008
Foreword cannot be responsible for solving drug problems, rather such responsibility is shared between an individual drug user and the community in which he or she lives. Thus, drug use must be treated according to scientific research and not an ideology. Ideology may only lead to a stricter repression, a breach of fundamental human rights or to apathy, ignoring calls to recognise science and profession as well as deficient actions. It is necessary to check appropriateness and effectiveness of existing assistance programmes for such groups. The present reports contain information on rights to health, appropriate health care and social security for vulnerable groups. Our publication intends to raise awareness on partnership communication under which a drug user and an expert together decide on a treatment suitable to their views and opportunities. It advocates cooperation and a balance of various high threshold and low threshold approaches, a greater involvement of outreach work as a method to approach 'hidden' populations and a larger investments into preventative approaches. We hope that the information collected on extremely moving stories on (not) overcoming obstacles will contribute towards better accessibility, attainability and acceptance of health care and social services for drug users. As drug users may also be co-creators of programmes and at the same time co-responsible for their challenges, the results of treatment are better. Empowering drug users, together with assistance on personal growth, acknowledges them as entities within different system frameworks. It means joint elimination of barriers and replacing obtrusive role of medicated or criminal entities, with a distribution of decision-making power and responsibility between all the subjects. To this end, it is necessary to enable setting up self-help groups for drug users. Within the context of respecting a democratic approach and human rights, it is important to also support organised meetings for individuals and groups who, due to their vulnerability and life deprivation, cannot help themselves. The reports draw attention to unsatisfied needs of 'hidden' drug users and their needs for social integration. Taking everything into consideration, we are aware of fundamental deficiencies. The book mainly reports on aspects of drug users and it does not take into consideration the needs of their extended family, as well as of experts and their organisations. One can refer to an old saying that 'everyone sees the world through his own eyes'. It will therefore be important to continue learning about the needs of all subjects in solving drug problems. We wish to stimulate a more constructive dialogue, improve the exchange of information between different partners, working on enforcing rights of all threatened and vulnerable groups, and at the same time, point to their shared responsibility for addressing difficulties. Mag. Dušan Nolimal, Msc, Dr. med., Head and main researcher of the Slovenian team 8 Contents Partner organisations in five European member states developed and implemented the study in their own country, adapted to the local situation and to their specific target group. The organisation Enghaven in Denmark focussed its research on barriers to access to social and health services for homeless people, sex workers and drug users. Unfortunately, the report of this Danish study could not be included, due to problems in the process of the research. The Research Institute on Drug Studies (RIDS) in Hungary centred its research on barriers to access to social and health treatment for problem drug users currently out of treatment. The goal of this study was to reveal the reasons why this high-risk group was denied any given form of treatment and needle exchange programmes-or if they did gain entry, what difficulties they were facing. The research sample of this study consisted of 67 problem drug users. The pilot test took place in March 006 and data collection took place from April 006 to July 006. The results of the Hungarian study showed that methadone maintenance treatment and drug rehabilitation services were particularly hard to access, while needle exchange services and day care were judged easily accessible. Long waiting lists were one hindrance mentioned A last important remark is that organisations that strive to involve their target groups have to make sure that preconditions are met for the members of that target group. Working with drug users for example means that participants need to be able to fulfil their daily needs, like taking methadone. It may also mean paying them for their activities in order to boost their motivation. Organisation Country Research focus Research Institute on Drug Studies Hungary Barriers to access to social and health services for problem drug users currently out of treatment. 1 3. Barriers to treatment and needle exchange among problem drug users in Budapest been in treatment with those who had been seeking treatment. The basic difference between members of the two groups is the length of their drug career: those seeking treatment had been using drugs for a longer period of time-that, presumably, is the reason why they are seeking help. 3.3 Methods Problem drug use According to the EMCDDA definition, the problem drug user is one who uses a drug intravenously and/or one who has been using opiates, cocaine and/or amphetamine related substances regularly and for a long time (EMCDDA, 1999.). Drug use treatment When using the definition of problem drug use, we made use of EMCDDA guidelines (EMCDDA, 00.). According to these, any provision aimed at health-and/or psychosocial disorders so that complete or partial abstinence from drugs is reached, is qualified as treatment, as long as it takes place in a well-defined environment. Using this definition, we may define as treatment the following: outpatient services; residential services; drug rehabilitation; day care/provision; methadone maintenance; and psychosocial forms of care offered by low-threshold services. Although needle and syringe exchange does not qualify as treatment, we have looked at circumstances of and obstacles to accessing this service as well.
Engaging people who use drugs in policy and program development: A review of the literature
Substance Abuse Treatment, Prevention, and Policy, 2012
Health policies and programs are increasingly being driven by people from the community to more effectively address their needs. While a large body of evidence supports peer engagement in the context of policy and program development for various populations, little is known about this form of engagement among people who use drugs (PWUD). Therefore, a narrative literature review was undertaken to provide an overview of this topic. Searches of PubMed and Academic Search Premier databases covering 1995–2010 were conducted to identify articles assessing peer engagement in policy and program development. In total, 19 articles were included for review. Our findings indicate that PWUD face many challenges that restrict their ability to engage with public health professionals and policy makers, including the high levels of stigma and discrimination that persist among this population. Although the literature shows that many international organizations are recommending the involvement of PWUD...
Bridging the Divide: Drinking among Street Drug Users
American Anthropologist, 2006
In this research report, we present findings on drinking among drug users from a larger multimethod study of the public health consequences of emergent, changing, and understudied drug-related behavioral patterns among street drug users in Hartford, CT. Although drinking and illicit drug use traditionally have been studied in anthropology as separate cultural domains, this conceptual division has hindered examination of the significant level of drinking among street drug users, the motivations for heavy drinking in this population, and the public health consequences of mixing alcohol and other drugs, including drug relapse. [Keywords: drinking, drug use, relapse]
International Journal of Drug Policy, 2018
Background: There has been increasing interest in harm reduction initiatives for street-involved people who drink alcohol, including non-beverage alcohol such as mouthwash and hand sanitizer. Limited evidence exists to guide these initiatives, and a particular gap is in research that prioritizes the experiences and perspectives of drinkers themselves. This research was conducted to explore the harms of what participants termed "illicit drinking" as perceived by people who engage in it, to characterize the steps this population takes to reduce harms, and to identify additional interventions that may be of benefit. Methods: This participatory qualitative research drew on ethnographic approaches including a series of 14″town hall"-style meetings facilitatied and attended by people who self identify as drinking illicit or non-beverage alcohol (n = 60) in Vancouver, British Columbia. This fieldwork was supplemented with four focus groups to explore emerging issues. Results: Participants in the meetings described the harms they experienced as including unintentional injury; harms to physical health; withdrawal; violence, theft, and being taken advantage of; harms to mental health; reduced access to services; and interactions with police. Current harm reduction strategies involved balancing the risks and benefits of drinking in groups and adopting techniques to avoid withdrawal. Proposed future initiatives included non-residential managed alcohol programs and peer-based supports. Conclusions: Illicit drinkers describe harms and harm reductions strategies that have much in common with those of other illicit substances, and can be interpreted as examples of and responses to structural and everyday violence. Understanding the perceived harms of alcohol use by socially marginalized drinkers and their ideas about harm reduction will help tailor programs to meet their needs.
Substance abuse treatment, prevention, and policy, 2024
Background Since 1996, an urban community-based organization whose primary mission is to serve diverse94 and emerging community health needs has provided screening, testing, overdose prevention and training, referrals, and access to treatment for substance use disorders (SUD) and communicable diseases such as HIV through its Life Points harm reduction program. Methods As a partner in a State survey in 2021, the community organization recruited a convenience sample of people who use drugs to participate in a survey focused on their substance use, healthcare, and barriers to SUD services. Community health workers conducted outreach and used an encrypted identifier to collect data from a convenience sample of harm reduction participants regarding demographics, legal justice, engagement in harm reduction and access to healthcare. Evaluators entered paper surveys into Qualtrics for reporting and summative analysis.
Canadian Journal of Public Health, 2019
Objectives Globally, engaging people who have used drugs, or peers, in decision-making has been increasingly touted as a best practice approach to developing priorities, programs, and policies. Peer engagement ensures decisions are relevant, appropriate, and effective to the affected community. However, ensuring that inclusion is accessible and equitable for those involved remains a challenge. In this study, we examined the perspectives of people who use or have used illicit drugs (PWUD) on peer engagement in health and harm reduction settings across British Columbia (BC), Canada. Methods The Peer Engagement and Evaluation Project used a participatory approach to conducting 13 peer-facilitated focus groups (n = 83) across BC. Focus group data were coded and analyzed with five peer research assistants. Themes about the nature of peer engagement were generated. From this analysis, peer engagement barriers and enablers were identified. Results Barriers to peer engagement included individual, geographical, systemic, and social factors. Issues related to stigma, confidentiality, and mistrust were intensely discussed among participants. Being Bouted^in one's community was a barrier to engagement, particularly in rural areas. Participants voiced that compensation, setting, and the right people help facilitate and motivate engagement. Peer networks are an essential ingredient to engagement by promoting support and advocacy. Conclusion PWUD are important stakeholders in decisions that affect them. This cross-jurisdictional study investigated how PWUD have experienced engagement efforts in BC, identifying several factors that influence participation. Meaningful engagement can be facilitated by attention to communication, relationships, personal capacity, and compassion between peers and other professionals.
Substance Abuse Treatment, Prevention, and Policy
2006
Background: Romantic partnerships between drug-using couples, when they are recognized at all, tend to be viewed as dysfunctional, unstable, utilitarian, and often violent. This study presents a more nuanced portrayal by describing the interpersonal dynamics of 10 heroin and cocaine-using couples from Hartford, Connecticut. Results: These couples cared for each other similarly to the ways that non-drug-using couples care for their intimate partners. However, most also cared by helping each other avoid the symptoms of drug withdrawal. They did this by colluding with each other to procure and use drugs. Care and collusion in procuring and using drugs involved meanings and social practices that were constituted and reproduced by both partners in an interpersonal dynamic that was often overtly gendered. These gendered dynamics could be fluid and changed over time in response to altered circumstances and/or individual agency. They also were shaped by and interacted with longstanding historical, economic and socio-cultural forces including the persistent economic inequality, racism and other forms of structural violence endemic in the inner-city Hartford neighborhoods where these couples resided. As a result, these relationships offered both risk and protection from HIV, HCV and other health threats (e.g. arrest and violence). Conclusion: A more complex and nuanced understanding of drug-using couples can be tapped for its potential in shaping prevention and intervention efforts. For example, drug treatment providers need to establish policies which recognize the existence and importance of interpersonal dynamics between drug users, and work with them to coordinate detoxification and treatment for both partners, whenever possible, as well as provide additional couples-oriented services in an integrated and comprehensive drug treatment system.
2014
Background Grounded in a community-based participatory research (CBPR) framework, the PROUD (Participatory Research in Ottawa: Understanding Drugs) Study aims to better understand HIV risk and prevalence among people who use drugs in Ottawa, Ontario. The purpose of this paper is to describe the establishment of the PROUD research partnership. Methods PROUD relies on peers’ expertise stemming from their lived experience with drug use to guide all aspects of this CBPR project. A Community Advisory Committee (CAC), comprised of eight people with lived experience, three allies and three ex-officio members, has been meeting since May 2012 to oversee all aspects of the project. Eleven medical students from the University of Ottawa were recruited to work alongside the committee. Training was provided on CBPR; HIV and harm reduction; and administering HIV point-of-care (POC) tests so that the CAC can play a key role in research design, data collection, analysis, and knowledge translation activities. Results From March-December 2013, the study enrolled 858 participants who use drugs (defined as anyone who has injected or smoked drugs other than marijuana in the last 12 months) into a prospective cohort study. Participants completed a one-time questionnaire administered by a trained peer or medical student, who then administered an HIV POC test. Recruitment, interviews and testing occurred in both the fixed research site and various community settings across Ottawa. With consent, prospective follow-up will occur through linkages to health care records available through the Institute for Clinical and Evaluation Sciences. Conclusion The PROUD Study meaningfully engaged the communities of people who use drugs in Ottawa through the formation of the CAC, the training of peers as community-based researchers, and integrated KTE throughout the research project. This project successfully supported skill development across the team and empowered people with drug use experience to take on leadership roles, ensuring that this research process will promote change at the local level. The CBPR methods developed in this study provide important insights for future research projects with people who use drugs in other settings.
Addressing the Burden of Alcohol and Drug Abuse
East African Scholars Journal of Medical Sciences, 2024
The burden of substance abuse is an enormous public health issue. Globally, 1 in every 17 people 15-64 years uses at least one drug. Cannabis as the most used drug. In Kenya, 1 in every 6 people between 15 and 65 years are currently using at least one drug. The aim of this study was to determining the burden of alcohol and drug abuse in Kenya, and suggest ways of reducing the burden. A scoping review of literature was conducted through the Google Scholar according to the criteria and methodology by Arksey and O’Malley (2005). 96 studies fully met the inclusion criteria. The study concluded that Kenya faces a heavy burden of alcohol and drug abuse that causes enormous physical, mental, biological, social, spiritual, psychological, emotional, economic, intellectual, developmental and environmental sufferings, robing individuals of social and economic opportunities, imposing an enormous burden on families and the society, and negatively affecting the country’s development efforts. Recommendations for addressing alcohol and drug abuse include: enhancing awareness regarding alcohol and drug use-related harms and its consequences; advocating for healthy, balanced lifestyles; normalizing self-love, self-care and seeking help; resisting peer pressure; building resilience; fostering strong interpersonal relationships; scaling up positive parenting and strengthening families; addressing stressful situations; developing life skills; enforcement of strong measures to regulate access to alcohol and drugs; early identification and reduction of alcohol and drug use; avoiding stigmatization and discrimination; using multi-dimensional family therapy strategies; scaling up broad-based, positive, holistic, innovative, affordable and evidence-based prevention, treatment, recovery and rehabilitation approaches/interventions; including gender-responsive, trauma-informed and anti-oppressive approaches in alcohol and drug addiction treatment as well as gender-based violence interventions; use of court-mandated treatment for opioid use disorder; and ensuring a robust clinical, public health and research capacity in alcohol and drug abuse.