Socialno delo, Vol. 38 (1999), Part 4-6
SOCIAL WORK PRAGMATICS IN THE FIELD OF DRUG-USE - HARM REDUCTION
ARTICLES
Injection of Drugs, Rapid Spread of HIV, and 'Risk Environment': Factors that Imply Rapid Assessment and Response - 261, (Abstract)
Fieldwork with Drug Users: General Principles and Experiences of Fieldwork in Slovenia to Date - 293, (Abstract)
The Experience of Dutch Drug-users' Organisations with Harm Reduction: With Instructions for a Safer Use of Drugs - 315, (Abstract)
Project STIGMA - A Retrospective: For Pragmatic Social Work in the Field of Drugs - 333, (Abstract)
Images of Heroin Use in Slovenia from the Point of View of Harm Reduction: A Preliminary Research Report - 341, (Abstract)
ABSTRACTS
Abstracts
Vito Flaker
Social Construction of the Drug-user's Career
The paper presents the drug-user's career as a psychosocial process in which learning the techniques of enjoyment, roles and the expectations of the individual and the surroundings play an important part. The existing concepts of enjoyment and addiction are laid out. The discussion on drug-use is seen as dominated mainly by a black and white image which in a chiaro-schurro, as it were, represents two figures: a bad junkie and a good abstainer; the rest of the picture is dimmed. Analysing these concepts and taking into account domestic and foreign ethnographic findings, the author makes conclusions as to what in fact being a junkie means. He designs a classification in order to develop a more logical picture, presenting at once the possible stages or phases of the career of heroin use, as well as the use of other opiates, and the possible types of enjoyment. The typology is useful for tracing careers, and even though it is conceived as a linear progression from non-enjoyment to the junkie lifestyle, there are, in every stage, exits from the career or returns to a less intensive stage. The available data (even from the author's own quantitative research) support the thesis that enjoyment is structured as concentric circles in which, characteristically, the increasing intensity of the user's role and of actual enjoyment is matched by a lesser number of users of the corresponding type.
Keywords: drug-use typology, junkisation, figures of enjoyment, counter-figures, rarefaction of the role of junkie.
Dr. Vito Flaker lectures at University of Ljubljana School of Social Work.
Dragica Fojan
Drugs as an Argument for Whatever
There is a gap between the declared goals of the (approximately eighty years lasting) prohibitive policies, briefly characterised by the famous notion 'drug free society', and the actual state of affairs. This casts doubt on the notion according to which war against drugs is war against danger/destructiveness of psychoactive substances. As a consequences, it also questions the validity of speech about the ineffectiveness of war against drugs. The purpose of the paper (in which the author's starting point is the definition of a drug as an 'argument for whatever') is to identify the contradictions concerning aetiology, prevalence and strategies/policies that can be observed in the prohibitive interpretation of the phenomenon of drugs.
Keywords: the phenomenon of drugs, prohibitive policies, war against drugs, drug free society, rhetoric of drugs, primary prevention, harm reduction.
Dragica Fojan, M. A., is a social pedagogue and works for the Stigma Association, Ljubljana.
Zoran Kanduč
On some Normative Questions Related to the Policy on Illegal Drugs
The model of repressive (penal) control of illegal drugs is usually criticised on the basis of its evid-ent inefficiency and even counter-productive effects (it creates social and personal problems that are not in the least related to the use of drugs or even with addiction). The paper outlines an objection to the prohibitionist policy against drugs which derives from the normative point of view that everybody has a right to use any drug of his or her choice, and the according personal responsibility for that practice. Several possible normative arguments are suggested, for example, the right of 'self-management' of one's body and the right to harm oneself.
Keywords: drug policy, the right to use, self-management of the body, harm reduction.
Dr. Zoran Kanduč is researcher at the Criminology Institute of University of Ljubljana Faculty of Law and a lecturer of criminology at the faculty.
Tim Rhodes, Gerry V. Stimson, Nick Crofts, Andrew Ball, Karl Dehne, Lev Khodakevich
Injection of Drugs, Rapid Spread of HIV, and 'Risk Environment': Factors that Imply Rapid Assessment and Response
By comparing two geographical areas, South-East Asia and countries of the former Soviet Union, the authors develop a thesis, according to which social, cultural, economical and political environments determine the spreading of HIV amongst intravenous drug users. They point out the need to extend and shift the paradigm of research and of prevention planning away from individual risk factors to taking into account wider social and material factors that are still quite obscure but which condition the spreading of infections. A rapid and sensible response is crucial for the mastering of epidemics and can only be developed by using a variety of research methods, including qualitative methods that make possible the formation, supplementation and interpretation of the epidemiological measurement of environment. This approach also makes it possible for the assessment of the situation to participate at changing the risk environment.
Keywords: risk environment, drug injection, HIV epidemics, rapid assessment and response, public health, prevention, paradigm shift.
The authors are all involved in developing public health approaches to research and intervention for drug users in a variety of international contexts. Tim Rhodes is a Senior Research Fellow in the Sociology of Public Health at the University of London, UK; Gerry Stimson is Professor of the Sociology of Health Behaviour at the University of London, UK; Nick Crofts is a Senior Epidemiologist at the Macfarlane Burnet Centre for Medical Research in Australia; Andrew Ball is a Medical Officer at the World Health Organisation; Karl Dehne is a Senior Epidemiologist at the University of Heidelberg in Germany; and Lev Khodakevich is a Programme Advisor at UNAIDS in Switzerland.
Bojan Dekleva
Recreational Use of Drugs
The term 'recreational' use of drugs has come to frequent use in the 90's. It refers to, firstly, a certain pattern of drug use (how, when, what, who, where), and secondly, to a particular theoretical explanation of the nature of drug use. This explanation, sometimes called 'cultural', 'normative' or 'consumerist', competes with other explanations, e. g., medical or (social-)pathological and subcultural ones. Recreative use of drugs emerges in new, specific social circumstances. They are characterised by a prolongation of adolescence, the aggravated conditions of passage to full adulthood, the formation of very different, individualised courses of life, scenarios and careers, as well as - as it is called by some sociologists of the youth - the situation of manifold life risks. The latter demands that an individual develops idiosyncratic strategies of managing those risks, or that he or she develops the skill of taking risks as one of the basic life skills. On the other hand, these social conditions demand of professionals and administrative social subsystems to differentiate and weigh the risks, related to the use of drugs, and to respond in a differentiated manner. The policy of harm reduction is one of such responses. The paper relates this theoretical orientation to the results of a research on the use of ecstasy and other 'dance' drugs amongst the youth, and ends with a discussion on the implications of the theory of recreational use of drugs for preventive and other kinds of intervention.
Keywords: recreational use of drugs, risk society, ecstasy, 'dance' drugs.
Dr. Bojan Dekleva is an associate professor at University of Ljubljana Faculty of Education.
Peter Stefanoski
Motivational Interview
Motivational interview is a technique of stimulating a change of behaviour. It originates in the 'trans-theoretical' model of change. Motivation is seen as a relational-dynamic issue and not as a personality trait. An individual's motivation changes from one situation to another. By suitable professional interventions motivation for change can be raised.
Keywords: motivation for change, phases of change, problems deriving from using drugs.
Peter Stefanoski is a social worker and counsellor to the Minister of labour, family and social affairs.
Dušan Nolimal
Fieldwork with Drug Users: General Principles and Experiences of Fieldwork in Slovenia to Date
The paper presents the principles and types of fieldwork which, as a form of intervention in the community, supplements other public health and social activities. The reasons for the introduction of fieldwork in Slovenia include two facts: first, the existing interventions have not succeeded to reach all targeted individuals, and second, they have not offered all the services targeted groups need. The aim of fieldwork is mainly to reach individuals and groups who may need health and social services but are not in contact with them. Fieldwork has to be developed on the basis of epidemiological assessment in the field and the needs of drug users. What is also needed in fieldwork is supervision. For a systematic introduction of fieldwork and its carrying out the following is necessary: assessing the need of fieldwork, planning aims, tasks and strategies, selecting and educating fieldworkers, establishing contacts in the field, and carry out field services.
Keywords: basic principles of fieldwork, target groups, planning, evaluation.
Dušan Nolimal is a specialist of social medicine and an epidemiologist at the Institute of Health Protection in Ljubljana.
Jože Hren
Fieldwork
In the last few years, drug use has become one of the most important topics of everyday life. Social work could significantly implement its approach in the field of harm reduction and field work. So far, non government organisations played a more important role. One of the first, if not the first project in Slovenia that has systematically implemented field work is Aids Foundation Robert. With modest financial resources and without any relevant political support it has succeeded to develop several autonomous but mutual related activities: field work, drop-in, counselling, needle/syringe exchange.
Keywords: fieldwork, drug users, social work, low-threshold programmes, harm reduction.
Jože Hren is a social worker, employed at the Centre of Social Work Logatec, and the head of the Phare project of harm reduction.
Milan Krek
Fieldwork - An Opportunity for Interdisciplinary Approach
In Slovenia, every science or profession engaged in working with drugs has its own approach to the problem, which is not bad, but those approaches are frequently not in line with each other. The demands of a wholesome treatment of drug use become clear in everyday life, when a drug dependant who does or does not wish to be treated needs to be prescribed one and only one wholesome therapy, in which a variety of professionals' activities will supplement one another or follow one another in a certain sequence. Fieldwork is an opportunity for interdisciplinary work of several professionals, as it calls for the inclusion of social workers just as much as physicians, sociologists, psychologists and drug users themselves, so that co-operation is by all means more important than whose profession will dominate individual programmes.
Keywords: drug use, fieldwork methods, co-ordination of professionals, interdisciplinarity.
Milan Krek is a physician and the Director of the Republic of Slovenia Drug Bureau.
Theo van Dam
The Experience of Dutch Drug-users' Organisations with Harm Reduction: With Instructions for a Safer Use of Drugs
The Netherlands has a twenty year long tradition of interest groups and organisations of drug users which have always been engaged in the questions of drug policy and in planning and implementing services for the people who use drugs. The paper stresses the need for co-operation between users and professionals, frames the work with users in everyday life situations, and points out that users themselves may often be the best experts. It is also intended to encourage drug users to acknowledge to a greater extent their capacities and abilities to get more actively involved in solving problems that involve their lives. The descriptions of a variety of imaginative actions at which the author participated challenge users to be creative and innovative in their everyday struggles.
Keywords: Dutch drug user organisations, activism, safer drug taking, prevention, HIV, peer counselling, fieldwork.
Theo van Dam, once a drug user, is the national co-ordinator of the drug users' interest groups in the Netherlands.
Kaja Tratnik
Fieldwork Methods
The paper presents examples of her work as fieldworker. By analysing some situations, she points out the importance of the first contact with the user and describes the peculiarities of fieldwork which demands from the worker a certain degree of personal integrity and knowledge. It is a precondition for quality fieldwork that the worker not only understands the problem of using illegal drugs and the character of fieldwork, but is also capable of empathy with each user. She takes establishing a contact with a user as a process (and not an event) whose length may vary and can be divided into phases.
Keywords: fieldworker, drug-user, contact, HIV, drug, dealer.
Kaja Tratnik is a social worker, a counsellor in association 'Up' (Hope), a non-governmental organisation for aid to the parents of addicts.
Dare Kocmur
Project STIGMA - A Retrospective: For Pragmatic Social Work in the Field of Drugs
The paper discusses the initial activities and the development of the first non-governmental organisation in the field of reducing the harm related to drug use. It presents the first initiative towards the inclusion of drug users as the actors of self-help in co-operation with various medical and social work professionals. The programme aimed at the secondary prevention of sexually transmitted diseases (HIV, hepatitis), advocacy of methadone maintenance, counselling on safer or less damaging use of drugs, and enticing initiatives to grant human rights in the various institutions that carry out some form of 'treatment' of drug users (health, social work, jurisdiction). The paper concludes with the results of Stigma's needle exchange programme.
Keywords: war on drugs, HIV, hepatitis C, encounter strategies, low-threshold programmes, harm reduction, prevention, needle exchange, counselling, outreach work.
Dare Kocmur is a social worker and the programme co-ordinator in the Stigma Association, Ljubljana.
Vito Flaker, Vera Grebenc, Nino Rode, Janko Belin, Dragica Fajon, Alenka Grošičar, Ilonka Feher, Mateja Šantelj, Andrej Kastelic, Darja Zupančič, Zlato Merdanović
Images of Heroin Use in Slovenia from the Point of View of Harm Reduction: A Preliminary Research Report
The paper is an abridged report on the results of a research that was conducted, as a part of the Harm Reduction Phare Project, at University of Ljubljana School of Social Work. The bulk of the material on which this report is based consists of interviews with users, the themes are presented chiefly from the point of view of the users, and often in their own words. In methodology, data processing and in the report, the researchers have consistently taken into account the users' perspective. No unified theory of heroin use is sought, rather, the gathered material is the basis on which the authors build the image of heroin use and a map of the users' practices in Slovenia. The main topics of both the research and this report are: knowledge and perception of drug use in the wider community, accessibility of drugs, points of view of drugs, characteristics of drug using groups, geographical placement of drug users, health issues, violence, employment, accommodation, contacts with relatives, peer groupings, career, drug dealing, risks of injecting and overdose, sex and drugs, prostitution, and evaluation of services. An important result of the research is that it presented the social aspects of harm reduction as opposed to the health factors that have been emphasised by all recent strategies of harm reduction.
Keywords: harm reduction, drug ethnography, career, risks, availability of drugs, service evaluation.
Dr. Vito Flaker lectures at University of Ljubljana School of Social Work. Vera Grebenc is a social worker and the co-ordinator of the Harm Reduction Phare Project. Nino Rode is a sociologist and an assistant lecturer at University of Ljubljana School of Social Work. Janko Belin is a social worker and collaborates with Fužine Counselling Office on harm reduction projects; he also leads the project of Slovene drug-users' self-organisation. Alenka Grošičar and Mateja Šantelj are social workers, working at AIDS Foundation Robert. Ilonka Feher is a student at University of Ljubljana School of Social Work and works on Stigma and AFR projects. Andrej Kastelic is a psychiatrist and head of the Centre for the Treatment of Addictions in Ljubljana. Darja Zupančič is a social worker. Zlato Merdanović is a collaborator of Stigma.