HARMFUL+OR+HELPFUL?+-+The+debate+on+Harm+Minimisation+vs+Abstinence

**STUDENT NAME:** Natalie Grondin **STUDENT NUMBER:** n8277150 **TUTOR****:** Abbey Diaz


 * THE ARTEFACT **

The presented cultural artefact is a poster taken from the Harm Reduction Victoria website, warning users of the dangers relating to injecting drugs. The website was founded in 1987 by a group of drug users, their families, friends and allies as part of the communities response to the threat of a HIVAIDS epidemic among injecting drug users. Their mission statement proclaims: Harm Reduction Victoria works to advance the health, dignity and social justice of people who use drugs in Victoria. Funded primarily by the VIC Department of Health, HRVic provides education, practical support, information and advocacy to users of illicit drugs, their friends, and allies. HRVic has often led the way in developing innovative approaches to peer education, community development and community empowerment for people who use drugs.


 * THE PUBLIC HEALTH ISSUE **

A number of serious public health issues are linked to illicit drug use, both within Australia and worldwide. These include illness and disease, injury in workplace, violence, crime, incarceration, breakdown in families and relationships, homelessness and even death (Cameron & Ritter, 2005). The image above is an example of the strategies being implemented to minimise the spread of drug related diseases and harm. The public health issue that is highlighted by the image is the need to treat the issue as a health problem and not necessarily a criminal one. The issue remains that not all individuals can abstain from drug use therefore harm reduction aids in keeping users alive and healthier for longer, before they are ready for treatment.


 * LITERATURE REVIEW **

Illicit drug use is a major societal problem that puts increased demands on community, judicial and health services (Wright and Walker 2007). Recent statistics show that, as of 2010, 7.3 million people in Australia reported having used an illicit drug at least once in their life and almost 3 million had used an illicit drug in the 12 months before this data was taken (AIHW, 2011). The most common drugs used are cannabis, ecstasy, hallucinogens, cocaine and methamphetamines (NDSHR, 2010). Previously, males were more likely to be users however over recent years (2007) female drug use has increased significantly (AIHW, 2011). Subpopulation groups with high proportions of recent use of illicit drugs included those who were unemployed, had never been married, identified as being Aboriginal or Torres Strait Islander, and identified as homosexual or bisexual (AIHW, 2011) . All of these individuals however require serious help as addiction is defined as being a compulsive physiological and psychological need for a habit-forming substance (Wright and Walker 2007). It consumes the lives of those affected and therefore it is important an answer is found to help further aid the issue. The big question however is what works: harm minimisation or abstinence.

The management of illicit drug use has been challenging governments, globally, for more than 30 years (Ministerial Council on Drug Strategy 2009). Two opposing views exist when involving the strategic direction of drug policies, harm minimisation and abstinence. Each of these positions take a philosophically distinct view of illicit drug use and appropriate responses (Tammi & Hurme, 2007). The basis of Australia’s drug strategy since 1985 has been harm minimisation (Miles & Maureen, 2010). This does not condone drug use but rather aims to reduce drug related harm by improving the health, social and economic outcomes for the community and individuals via a wide range of approaches (Cameron and Ritter, 2005). There is certainly a lot of confusion over the use of terms whether it be harm minimisation or harm reduction. Harm minimisation is a philosophical approach, and harm reduction is the specific interventions adopted to limit use (Miles & Maureen, 2010). Over the years this strategy has been altered and updated to fit Australia’s ever changing and growing society, the latest version (2010-2015) is desi <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">gned to suit todays Australia. This strategy is built on the three pillars of demand, supply and harm reduction (Cameron and Ritter, 2005).

<span style="background-color: #fcfcfc; font-family: 'Helvetica Neue',Helvetica,Arial,sans-serif; font-size: 16px;">The theory surrounding abstinence based approaches, look into stopping the demand for drugs through the use of scare campaigns and militarized drug raids to kill the supply, therefore aiming to solve the perceived ‘drug problem’. A prime example of this was the prohibition of alcohol in America during 1919-1933, it failed however to eradicate the issue (Miron & Zwiebel, 1991). The same problem is seen within Australia, despite strict laws being in place to enforce the prohibition of illicit drug use there is still overwhelming evidence to illustrate that the law is being disregarded and that the rate of drug related harms are increasing (Wodak, 2012). Abstinence appears to try and hide from the seriousness of the issue whereas minimisation polices acknowledge the inevitable use of substances within society, therefore focusing on reducing harm to the individual user and wider community (Commonwealth of Australia, 2004).

<span style="background-color: #fcfcfc; font-family: 'Helvetica Neue',Helvetica,Arial,sans-serif; font-size: 16px;">A paper conducted by Simmons, Sunderland, & Ritter at the University of New South Wales explored the existence of drug policy 'ideologies' in Australia. The aim of the paper was to identify whether distinct ideological groups exist within the Australian population in relation to abstinence and harm minimisation. There were two research questions:

//<span style="background-color: #fcfcfc; font-family: 'Helvetica Neue',Helvetica,Arial,sans-serif; font-size: 16px;">(1) Can the Australian public be categorised into groups of individuals who share similar opinions on drug policy questions? // //<span style="background-color: #fcfcfc; font-family: 'Helvetica Neue',Helvetica,Arial,sans-serif; font-size: 16px;">(2) If so, what are the characteristics of those groups? //

<span style="background-color: #fcfcfc; font-family: 'Helvetica Neue',Helvetica,Arial,sans-serif; font-size: 16px;">A t <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">otal of 15 drug policy questions were surveyed to find unobserved or latent heterogeneity within a sample, and determine distinct groups of individuals with similar responses to measured (observed) variables (Simmons, Sunderland, & Ritter, 2013). Data from the 2010 National Drug Strategy Household Survey (NDSHS), undertaken by the Australian Institute of Health and Welfare (AIHW) was utilised for the analysis of this paper (Simmons, Sunderland, & Ritter, 2013). The results showed that more than half of the Australian population do not hold strong views in relation to drug strategies, they hold views somewhere in-between. Analysis showed that those who support harm reduction interventions such as Needle and Syringe Programs (NSP's) do not equally support drug legalisation. Therefore from the data shown it can be concluded that rather than thinking of harm minimisation/abstinence dichotomy when considering individuals attitudes towards drug policies, it may be more accurate to think of three separate strong ideological positions: zero tolerance, harm minimisation and legalisation (Simmons, Sunderland, & Ritter, 2013). <span style="background-color: #fcfcfc; font-family: 'Helvetica Neue',Helvetica,Arial,sans-serif; font-size: 16px;">Due to there being no strong stance taken by the Australian population what has proved to work so far.

<span style="background-color: #fcfcfc; font-family: 'Helvetica Neue',Helvetica,Arial,sans-serif; font-size: 16px;">Needle and Syringe Programs were introduced in Australia to minimise the spread of blood borne viruses, particularly aids in the early 1990's <span style="font-family: Arial,Helvetica,sans-serif; font-size: 16px;">(National Centre in HIV Epidemiology and Clinical Research 2002 and 2009). <span style="background-color: #fcfcfc; font-family: 'Helvetica Neue',Helvetica,Arial,sans-serif; font-size: 16px;"> Records show a direct decrease in the number of users contracting HIV in relation to the introduction of NSP's (Commonwealth of Australia, 2002). Despite the facts speaking for themselves and showing overwhelming cost savings in <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">regards to both health and social costs saved due to the prevention of transmission of blood borne viruses, some are still against it (National Centre in HIV Epidemiology and Clinical Research 2002 and 2009). A quote taken from a submission made to the Australian House of Representatives Standing Committee on Family and Human Services (2007) said "Needle exchange pr <span style="background-color: #fcfcfc; font-family: 'Helvetica Neue',Helvetica,Arial,sans-serif; font-size: 16px;">ograms provide health benefits, but what is the real message being conveyed? That it is okay to use illegal substances? That it is okay to harm or kill yourself? That it is okay to continue treating the closest people to you like the scum of the earth? That it is okay to steal, rob and mug?' This quote clearly illustrates the side of those opposing the use of harm minimisation policies and programs, clearly disregarding the evidence and inevitability of the issue. While NSP's focus on improving the health issues linked to drug use, drug courts have been implemented as a way of minimising the social damage caused by substance abuse. Drug courts seek to reduce the social impact of stigmatisation and marginalisation by diverting minor offenders into compulsory treatment classes or by charging them with a small fine as a warning (Kutin & Alberti, 2004). Both NSP's and drug courts are polices within Australia that are making a difference in minimising drug related harm.




 * <span style="background-color: #fcfcfc; color: #ff0000; font-family: Arial,Helvetica,sans-serif; font-size: 130%;">CULTURAL AND SOCIAL ANALYSIS **

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">The illicit use of cannabis, hallucinogens and heroin was first reported in Australia in the early 1960’s, in red light districts (Manderson, 1993). The arrival of illicit drugs onto Australian soil was directly linked to the Vietnam War and was introduced as a collateral effect by American servicemen who spent ‘rest and recreation’ leave in Australia. This saw a consequent rise in funding for law enforcement, as the number of arrests increased in the 1960s and 1970s due to drug related crime and use (Degenhardt and Day, 2004). The late 1970’s and early 1980’s saw a peak in heroin use among the Australian population and this caused an increase in treatment seeking, drug overdoes deaths and drug related property crime (Degenhardt and Day, 2004). A drug culture had been created.

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">It can be seen that Australia has a long history when it comes to the misuse and abuse of illicit drugs; it has been an ongoing issue for years. The inability to eradicate the issue due to instinctual curiosity however further supports the need for harm reduction programs such as NSP’s rather than abstinence. The problem nonetheless is the stigma society has created for those who fail to abstain, leading to psychological damage (McKeganey, Morris, Neal, & Robertson, 2004). These groups of individuals are heavily impacted by the social constructs that surround ‘right’ and ‘wrong’, if users fail to abstain they may experience feelings of failure, lack self restraint and no moral judgment or personal control (Ahern, Stuber, & Galea, 2007). Research by Mc Keganey demonstrated the difficulties linked to abstinence, as the study of 859 illicit drug users found 8 months after rehabilitation and treatment only 11% had been able to have a period of abstinence of at least 2 weeks.

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">The use of certain drugs has shifted in the 2000’s as today’s younger demographic (18-29 years) are more likely to take part in the drug party scene, popping pills to get high. A study on recreational ecstasy use in the United States by Bahora in 2009, illustrated easy access/availability and social accommodations of use, contributed to the acceptance of ecstasy as a normal part of life for some individuals. What was more worrying however was the low risk perceptions of the social and health consequences of ecstasy and the normalization created around the intake of this illicit substance (Bahora, 2009). What attempts are being made to stop the normalisation of drug use?

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">Prevention strategies have been put in place by the Australian government to warn youths of the dangers linked to substance abuse, in an attempt to stop the normalization of drug use and the path to addiction (NSDS, 2010). The National Drugs Campaign is targeted at young Australians, at risk group, and aims to reduce their motivation to experiment with drugs by increasing their overall knowledge. This campaign has been running since December 2001, with the most recent phase taking place from December 2010 to June 2012 (AIHW, 2011). This phase was aimed to reduce the uptake of ecstasy and other illicit drugs through the encouragement and support, not to do illicit drugs (AIHW, 2011). A number of advertisements have been televised to the public to increase awareness and highlight the detriment linked to ecstasy and other illicit drug use alongside addiction.

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">Due to socio-ecomonic status, education, work skills, exposure to stigmatization and discrimination and the psychological and physical health consequences of drug use itself many illicit drug users are vulnerable (Digiusto & Treloar, 2007). A number of concerns are related to health services and treatment within Australia as only a small proportion of people with drug misuse problems seek aid and the ‘equity’ of access is questionable. The low participation rate is troubling given that such treatment, including harm minimisation, decreases the use of drugs, reduces the risk of serious health issues such as over-dose and improves the individuals quality of life <span style="font-family: Arial,Helvetica,sans-serif; font-size: 16px;">(Digiusto & Treloar, 2007). <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">To test the equity of the services available to Australian drug users Andersen and colleagues developed a model to predict and explain health services use in which equity of access to health services can be evaluated. Three different states within Australia were used including rural areas, 28% of the participants had never been treated before. The results illustrated that 82% were waiting too long, or no place for them in Residential Detox or Rehabilitation programs (Andersen, 2007). What was more worrying was that 28% did not satisfy the entry criteria and were turned away and this more than likely underestimates community needs as most participants were recruited through a drug service (Andersen, 2007). This illustrates that not everyone can get help when needed and that a number of factors play a large role when it comes to drug use and seeking aid (Anderson, 2007).

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">Bottom line is, drugs today are an integrated part of Australian society for a number of reasons. They are detrimental to the health of those involved and lead to a number of serious public health issues however seeing that we have failed to eradicate the issue it is important that programs continue to be put in place to minimise harm to users and we promote a healthy drug free lifestyle to the younger ‘at risk’ generations.


 * <span style="background-color: #fcfcfc; color: #ff0000; font-family: Arial,Helvetica,sans-serif; font-size: 130%;">ANALYSIS OF THE ARTEFACT AND LEARNING REFLECTIONS **

<span style="background-color: #fcfcfc; font-family: 'Helvetica Neue',Helvetica,Arial,sans-serif; font-size: 16px;">The cultural artefact chosen represents a helping hand for drug users. It may not be the conventional method that some feel is necessary but it has proven to make a difference to the lives of those addicted to illicit drugs. The poster taken from the HRVic website clearly highlights the importance of clean needle use and the dangers associated with sharing equipment. It is a good case of point as it focuses on the health impacts that are invisible to the naked eye. Even if the user cannot see the danger, they have been warned of its presence and the threat it poses to their life. The poster to me is not perfect, I understand that in an ideal world drug use and abuse would not exist. I however also understand that it is inevitable within our society and therefore extremely important that information, such as that on the HRVic website, reaches the ears and eyes of those using. This aids in prolonging the users life and potentially a path to treatment and recovery. As a result of this assessment piece I have learnt a great deal about the need for help not harm when it comes to drug use, each individuals story is different and they should not necessarily be treated like criminals but rather as a health issue that needs addressing in a pragmatic manner. Addiction is a hard cycle to break; harm reduction strategies can keep users alive on the possible road to recovery.



**<span style="background-color: #fcfcfc; color: #ff0000; font-family: Arial,Helvetica,sans-serif; font-size: 130%;">REFERENCES ** Ahern, J., Stuber, J., & Galea. S. (2007). Stigma, discrimination and the health of illicit drug users. //Drug and Alcohol Dependence, 88//(2-3). p. 188-196. Retrieved September 16, 2013 from []

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 16px; line-height: 23px;">Australian Institute of Health and Welfare 2011. 2010 National Drug Strategy Household Survey report. //Drug statistics series//, 25, 1-260. <span style="font-family: Arial,Helvetica,sans-serif; font-size: 17px;">doi: 10.1080/09595230600944528

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 130%;">Bahora, Masuma. (2009) Understanding recreational ecstacy use in the United States: A qualitative inquiry. //The International journal of drug policy//, 20, 62. doi: 10.1016/j.drugpo.2007.10.003

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 130%;">Commonwealth of Australia, Department of Health and Aging. (2004). Module 5: Young people, society and AOD:Facilitator’s guide. Retrieved from []

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 130%;">Digiusto & Treloar. (2007). Equity of access to treatment, and barriers to treatment for illicit drug use in Australia. //Addiction//, 102, 958-69. doi: <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">10.1111/j.1360-0443.2007.01842.x

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 130%;">Kutin, J.J., & Alberti, S. (2004). Law enforcement and harm minimisation. //Drug use in Australia: Preventing harm//, 2, 144-158. doi: 10.2109/09687637.2004.755325

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 130%;">Manderson, D. (1993). Heroins History Lessons. //<span style="font-family: Arial,Helvetica,sans-serif; font-size: 130%;">Australia: Oxford University Press //<span style="font-family: Arial,Helvetica,sans-serif; font-size: 130%;">, 55, 432-438. doi: <span style="font-family: Arial,Helvetica,sans-serif; font-size: 130%;">03126315

McKeganey, N., Morris, Z., Neal, J., & Robertson, M. (2004). What are drug users looking for when they contact drug treatment services: Abstinence or harm reduction? Drugs: Education, Policy and Prevention, 11(5), 423–435.

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 130%;">Ministerial Council on Drug Strategy. (2009). The National Drug Strategy‐ Evaluation and Monitoring of the National Drug Strategy 2004‐2009. Canberra: Australian Government Department of Health and Ageing. [] drugstrategy/publishing.nst/Content/consult‐eval (accessed 20.01.2010)

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 130%;">Miron, J.A., & Zwiebel, J. (1991) Alcohol consumption during prohibition. //The American Economic Review,// 81(2), 242-247. Retrieved from[]

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 130%;">Ritter, A. and Cameron, J. (2005). A systematic review of harm reduction. //Fitzroy: Turning Point Alcohol and Drug Centre//. 25, 611-624. doi: 10.1080/09595230600944529

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 130%;">Simmons, Sunderland & Ritter, (2013). Exploring the existence of drug policy 'ideologies' in Australia. //Drugs: Education and Prevention//, 20, 258-267. doi: 10.3109/09687637.2012.755494

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 130%;">Tammi, T., & Hurme, T. (2007). How the harm reduction movement contrasts itself against punitive prohibition. //International Journal of Drug Policy//, 18, 84–87. doi: 0955-3959

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 130%;">Wodak, A.D. (2012) The need and direction for drug law reform in Australia. //The Medical Journal of Australia//, 197(6), 312-313. DOI: 10.5694/mja12.10959. []

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 130%;">Wright, A. and Walker, J. (2007). Management of women who use drugs during pregnancy. //Seminars in Fetal & Neonatal Medicine//, 12, 114‐118. doi: 10.1113/j.drugpo.2007.12.162


 * <span style="color: #ff0000; font-family: Arial,Helvetica,sans-serif; font-size: 130%;">REFERENCES FOR IMAGES **

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">Can you see the blood, Retrieved from: http://hrvic.org.au

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">Quote on Harm Reduction, Retrieved from: http://izquotes.com/quote/56285

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">Users are people, Retrieved from: http://hrvic.org.au


 * <span style="color: #ff0000; font-family: Arial,Helvetica,sans-serif; font-size: 130%;">REFLECTIONS **

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