Results of a participatory needs assessment demonstrate an opportunity to involve people who use alcohol in drug user activism and harm reduction

Abstract

BackgroundDrug users’ organizations have made progress in recent years in advocating for the health and human rights of people who use illicit drugs but have historically not emphasized the needs of people who drink alcohol.MethodsThis paper reports on a qualitative participatory needs assessment with people who use illicit substances in British Columbia, Canada. We held workshops in 17 communities; these were facilitated by people who use illicit drugs, recorded with ethnographic fieldnotes, and analyzed using critical theory.ResultsAlthough the workshops were targeted to people who use illicit drugs, people who primarily consume alcohol also attended. An unexpected finding was the potential for drug users’ organizations and other harm reduction programs to involve “illicit drinkers”: people who drink non-beverage alcohol (e.g. mouthwash, rubbing alcohol) and those who drink beverage alcohol in criminalized ways (e.g., homeless drinkers). Potential points of alliance between these groups are common priorities (specifically, improving treatment by health professionals and the police, expanding housing options, and implementing harm reduction services), common values (reducing surveillance and improving accountability of services), and polysubstance use.ConclusionsDespite these potential points of alliance, there has historically been limited involvement of illicit drinkers in drug users’ activism. Possible barriers to involvement of illicit drinkers in drug users’ organizations include racism (as discourses around alcohol use are highly racialized), horizontal violence, the extreme marginalization of illicit drinkers, and knowledge gaps around harm reduction for alcohol. Understanding the commonalities between people who use drugs and people who use alcohol, as well as the potential barriers to alliance between them, may facilitate the greater involvement of illicit drinkers in drug users’ organizations and harm reduction services.

Responsabilização e participação: como superar o caráter tutelar no centro de atenção psicossocial álcool drogas?

“…In the present study, the users' objectives in the treatment partially differ from the professionals' objectives, because these latter determine as main objective the abstinence of drugs due to clinical issues identified, regardless of users' participation in this definition. The users' involvement in alcohol and other drugs treatment has high potential to work on objective from different groups, exploring their specific needs to adapt health care services (10) .…”

“…These objectives can be based on care strategies grounded in harm reduction principles, reconciling the user and the professional's interests by proposing specific actions to reach the negotiated objectives. However, the lack of knowledge on alcohol harm reduction, along with racism, violence and marginalization, constitute barriers to the collaboration and engagement of these groups in the treatment, because the harm reduction strategies worked on in services (supposing they are) are still focused on illegal drugs (10) . Despite the evident progress achieved in harm reduction, it is important that it is not restricted to the consequence of the use of intravenous drugs, but is concerned with programs related to other substances and other consumptions like alcohol, tobacco (5) and cocaine/ crack (snorted and smoked).…”

“If I knew I could get that every hour instead of alcohol, I would take the cannabis”: need and feasibility of cannabis substitution implementation in Canadian managed alcohol programs

“…Within abstinence-based health and housing systems, people experiencing homelessness paired with AUD describe cycles of displacement and discrimination within and between services, insecurity of personal safety and belongings, and loss of connection to social supports such as friends, family and for some Indigenous people, ancestral communities [ 5 , 15 ]. “Street-based illicit drinking” refers to the consumption of alcohol in harmful or otherwise stigmatized ways, including the use of non-beverage alcohol (e.g., hand sanitizer, mouthwash), often in situations where safer forms of regulated alcohol are unaffordable or unavailable [ 5 , 16 ]. Harms associated with street-based illicit drinking extend beyond consumption itself to include harms associated with consumption in criminalized spaces, including policing and charges related to public intoxication, targeted criminalization related to racism, and violence [ 17 ].…”

Research into action? The Eastside Illicit Drinkers Group for Education's (EIDGE) experiences as a community‐based group in Vancouver, Canada

“…Since 2011, this unique community has been able to unite and empower one another through EIDGE's weekly meetings by implementing programs that tackle issues specific to the needs of illicit drinkers. During this time EIDGE has created alcohol‐related harm reduction policies, programs and research .…”

“…Research has shown that the shared experiences of marginalisation felt by EIDGE members and the strategies created to reduce the harms (e.g. safe spaces and MAPs) are examples of structural violence . Creating safe spaces like MAPs are an important way to reduce the structural violence and alcohol‐related harms for chronic alcoholics .…”