According to Harm Reduction philosophy, it makes sense that any discussion of “progress” in a drug user’s life should be on a drug-user ’s terms. An article by Ruefli and Rogers (2004) describes some criteria drug users apply to measure their own progress, and challenges traditional ways of measuring based on quantity and frequency of drug use. They suggest that more appropriate measures are based on the extent to which drug users organize their lives around drug use, how much drug use is integrated into their lives and the extent to which it negatively impacts other aspects of their lives. The drug users in their study identified ten important life areas: making money; getting something good to eat; being housed/homeless; relating to families; getting needed programs/benefits/services; handling health problems; handling negative emotions; handling legal problems; improving oneself; and handling drug-use problems.
Sarah’s response: Note that for these users, the problem of drug-use is in last place on their list of program priorities, after important priorities like eating, making money, finding shelter, etc. This seems to indicate that until those basic, underlying needs are addressed, it would be premature to address drug use. Despite this seemingly common-sense notion, addressing drug use often the first or exclusive focus of treatment or recovery programs.
In their study with Harm Reduction workers in six Toronto agencies, Janet Murray and Mary Ferguson (2003) identify three stages to building stability in users’ lives (p. 45). The first stage is crisis management, characterised by depleting assets, living in crisis and cycling in and out of chaotic drug use. They point out that, although drug use can cause problems, it does not necessarily always lead to crisis. In come cases, “people can lead engaged, working lives while using (drugs)” (p. 46). As noted above, most of us use some kind of drug: caffeine, sugar, alcohol, etc. The next stage is foundation building, characterised by coping, accessing basic needs and building stability. Here, an important step is to find housing (p. 49). In the third stage, engaging, users begin to build assets, improve their quality of life, become more self-directed, and connect to the community and economy. At this stage, many people begin engaging in the community by attending community programs and volunteering.
Sarah’s response: I think engaging and relationship-building is the first step. Without this, you cannot start to work on the rest.