Studying Harm From Others’ Illicit Drug Use—Can Stigma Really Be Avoided?
In this commentary article the author discusses if it is possible to avoid stigmatizing of drug users when studying harm from others’ due to drug use and applying it in policy solutions.
In their paper ‘Applying a “Harm to Others” research framework to illicit drugs: political discourses and ambiguous policy implications’, Wilkinson & Ritter concludes that if only HTO from individual drug use is considered, discrimination and stigmatization of drug users will outweigh the benefits. The problem of stigmatization is assumed to be especially urgent in the case of illicit drug use, as it is the less well‐off users in society who will be most negatively affected. To justify an HTO‐approach on illicit drugs, Wilkinson & Ritter claim that it is necessary to include the other major form of HTO with respect to illicit drug use; HTO related to the illicit drug market.
This commentary argues that such a focus also entails a risk of stigmatizing users and that the concern of stigma and discrimination raised in this case illustrates a general challenge in policy work in the field of alcohol and drugs.
The major form of HTO related to the illicit drug market is drug‐related violent crime. As suggested by Wilkinson & Ritter, the very operation of the illicit drug market can be regarded as a cause of these harms. However, another perspective is that the foundation of the illicit market is the demand for illicit drugs in the population, i.e. individuals’ drug use. This individual responsibility for harms on the supply side could be revealed by an HTO perspective if the responsibility of users buying and consuming illicit drugs was acknowledged. This perspective has recently been used in the Swedish drug policy debate, where politicians accused drug users of being a main cause of the increasing violence in public places in Sweden. This example raises the question of whether it is possible to avoid stigmatization when studying substance use problems from an HTO perspective.
One attempt to avoid stigmatization is the total consumption model used in alcohol epidemiology. A recent discussion by Livingston & Raninen argued that the call for a shift of attention towards the whole population’s alcohol use implied a shared responsibility across the population for the harms caused by alcohol. In the early thinking around the total consumption model, a major argument for addressing all users was not only that it was assumed to be effective, but that it avoided blame and stigmatization of specific groups. As a result, policy measures directed to every [alcohol use] were selected, e.g. restricting availability and raising taxes. These measures aiming at making alcohol more difficult to obtain are found to be efficient in limiting harms from alcohol but also include, as mentioned by Wilkinson & Ritter, a risk that users will be stigmatized.
The present author concludes that, the concern of causing stigma to drug users raised in this commentary illustrates a general contradiction in policy work in the field of alcohol and drugs – the balance between making a behavior less attractive and avoiding producing more harms by attaching stigma to current users.