nursingforsocialjustice

There seem to be two parallel discussions happening in all the talk of the opiate crisis. One is about drug prohibition and the effects. The other is about the way that we are currently addressing substance use issues. I am not sure that addressing both of these questions separately is going to get us to where we need to go. Substance use issues are complex. Substance use is also complex. People use substances for different reasons. People also develop problems in life related to their substance use for various reasons. The way that this is currently being addressed is fractured. People seek treatment for substance use issues. People also seek treatment for their mental health issues. People seek help for the challenges that they experience related to poverty and homelessness. Are we farther ahead right now than we were 10 years ago? I am not so sure. To move away from conceptualizing people who have substance use issues as the result of moral failures substance use issues have been medicalized. The disease model was adopted. And the social model of substance use, the mental health/mental illness model of substance use as a coping mechanism, underlying mental health issue, large-scale social issues seems to be pitted against the disease model, which is also pitted against the moral model. Are we conceptualizing this in the wrong way? Are the underlying assumptions flawed?

If we already understand that people use substances for a diverse range of symptoms then, should we be focusing more on helping people understand when they may be experiencing problems with their substance use? Should we be trying harder to learn about why people who substances to begin with? Can we ask: what is your relationship with substances? This takes some deep self-reflection about our own values and beliefs about substances use. We need to explore our experiences with substance use, perhaps our own use, issues, struggles, but also those around us. If my loved one had struggles or continues to struggle with substances does this effect my values and beliefs? Similarly, our perspective on addiction, whether we view it as a moral issue, public health issue, chronic illness, medical issue etc. influences how we approach these situations. There are ethical implications of this, the same way that our religious beliefs may our ability to provide certain types of care interventions like birth control.

Can we use a timeline mapping exercise as an intervention? Does self-discovery and helping people understand why they use substances help them reduce problematic substance use? Can it prevent problematic substance use?

Are we focusing on the best interventions for the best outcomes? What are the best outcomes? Are substances the problem or a symptom?

Given that many people who have a problem relationship with substance use resolve it on their own without any deliberate outside intervention, should we be focusing on something else? Can community integration in itself, and creating meaningful social connections be a health intervention in and of itself? Can engaging people in the process be an intervention? Can community involvement be an intervention?

Peace,

Michelle D.