Harm Reduction: Conflicts with CJS
‘Contradictions that hinder the effort to reduce harm through the criminal justice system. The first is the fact that criminal justice systems themselves produce harms. …arrests, fines, community penalties, imprisonment and parole all infringe on individual freedoms and pleasures.
Countries do not use prison as a direct, rational measure to reduce crime. Rather, they choose — through a complex process of ideological, moral, political and juridical negotiation — the level of pain that they are willing to inflict on their citizens (Christie 1982). If we choose the level of harm that we inflict, we can also choose to reduce it.’ (p.380)
Stevens A., Stover, H. & Brentari, C. (2010) Criminal justice Approaches to Harm Reduction in Europe, pp379-402 in EMCDDA, Harm reduction: evidence, impacts and challenges EMCDDA, Lisbon, April 2010 On Blackboard
Issues with Treatment in the CJS
The second contradiction in pursuing harm reduction in the criminal justice system is that between the pursuit of abstinence and the acknowledgement of continuing drug use. Countries are obliged, through the UN drug conventions, to prohibit and to penalise the possession of certain substances.
The criminal justice system is the process that puts these obligations into practice. It is very difficult for the same system to acknowledge that the people under its control continue to defy the law. (p.380)
Stevens A., Stover, H. & Brentari, C. 2010 Criminal justice Approaches to Harm Reduction in Europe, pp379-402 in EMCDDA, Harm reduction: evidence, impacts and challenges EMCDDA, Lisbon, April 2010
Coercive Benefits Both drug courts and ‘coerced abstinence’ interventions deploy frequent
monitoring and chemical tests with the threat of graduated penal sanctions to deter re-initiating drug use and to reduce the probability of more serious offending and subsequent criminal sanctions.
Other enforcement measures may also have promise. Stricter controls on precursor chemicals appear to have at least short-term effects on methamphetamine consumption (Cunningham & Liu 2003). Work-place testing is argued by some to have led to reductions in adult drug use, by threatening job loss (Frenchet al. 2004). Evaluations of school testing programs provide hints that these, too, might reduce adolescent substance use. (p.351) [my emphasis]
Addiction: 101 341-347 (March 2006)
How much can treatment reduce national drug Problems? Peter Reuter & Harold Pollack School of Public Policy, University of Maryland and the RAND Corporation, CA, USA and School of Social Service Administration, University of Chicago, IL, USA
Abstinence Model
Addicts typically lie, hide, manipulate and hurt themselves and others they need confronting
Addicts need to hit rock bottom to see sense
People need to become clean – we can drug test them
Drug Free is the only way to be
Any level of use is unacceptable they have a lifelong disease and should never use again
People are either addicts or ex-addicts
ABSTINENCE
Eradicate drugs
Criminalisation
Stigmatisation
Separation
Homogenous view
Cure
Deny & deter
All use problematic
Counselling principles lost in enforcing abstinence
Listen
Respect the person – unconditional positive regard
Go at the clients pace
Be non judgmental
Empathy/care
Understand
No hidden agenda
Client led and owned
Based upon Ghodse, H. (2002) Drugs and Addictive Behaviour: A Guide to Treatment (3rd edn). Cambridge: Cambridge University Press
Abstinence Approach:RUSSIA
http://uculr.com/2012/04/05/solving-the-russian-hiv-crisis-with-harm-reduction-strategies%EF%BB%BF-2/
http://newsbeastlabs.thedailybeast.com/projects/death-by-indifference/
Harm Reduction -Risk Reduction
1. Pragmatic
2. Humane
3. Realistic
4. Engages
But doesn’t….
Harm Reduction condone drug use, encourages risk taking and removes the harsh realities of dangerous behaviour which people
who do drugs should suffer?
Do seat belts encourage speeding and dangerous driving
Should they be allowed?
My experience of pushing abstinence as a Probation Officer
1. Court Reports
2. Supervision - The evidence and dangers of drugs
3. Push the chance to become drug free
4. Detox - Cold Turkey
5. Rehab
6. Return –relapse –Guilt –Broken relationships
7. Rethink!
My journey from abstinence to risk
reduction mid 1980s
‘an abstentionist viewpoint - the expectation to give up is pressed from the outset of contact, the client succumbs to that pressure of expectation and attempts abstinence through either ’cold turkey’, ’detoxification programme’ or ’rehabilitation unit’.
Unfortunately the degree of success achieved is minimal with by far the majority failing and returning to the drug scene, increasing officer family and self frustration and feelings of failure. …
We have come to believe that a different philosophy should be adopted which incorporates both apparently irreconcilable views [abstinence vs maintenance] onto a scale or ladder of achievable targets. This philosophy begins with the pragmatic statement that:
From abstinence to risk reduction
’If it is, at a particular moment in time, impossible to cure a drug ‘addict’, one can at least try to create an environment for harm reduction.’
The implications of such a statement are that first one must identify those drug abusers who are dependent and differentiate from those who are experimental or recreational users.
One must also seek to ascertain what clients themselves wish to do, for whilst we might see their drug abuse as problematic, they may see it as the answer to a problem or may not wish to change their abuse for a variety of reasons. If one begins with the stance of ’Risk Reduction’, many more doors are open to engage with the client and discover ways of helping them.’ (pp. 123-124)
Buchanan, J. & Wyke, G. (1987) ‘Drug Abuse, Probation Practice and the Specialist Worker’, Probation Journal Vol. 34 No. 4 pp. 123-126
HARM REDUCTION
Live with drugs
Decriminalisation
Normalisation
Integration
Heterogenous view
Minimise harm
Freedom & responsibility
Some use problematic
Engaging & helping people
Harm reduction water level
Abstinence water level
People with drug
problems
ABSTINENCE
Eradicate drugs
Criminalisation
Stigmatisation
Separation
Homogenous view
Cure
Deny & deter
All use problematic
HARM REDUCTION
Live with drugs
Decriminalisation
Normalisation
Integration
Heterogenous view
Minimise harm
Freedom & responsibility
Some use problematic
Based upon
Goldberg, T. 1999, Demystifying drugs: A psychosocial perspective, Macmillan Press, London
Needle Park Zurich
http://dotsub.com/view/7119acc7-8ea0-4041-ba5d-ec5169bf08ae
66% swiss supported roll out
Learning from Switzerland
http://www.youtube.com/watch?v=Cco4BT-KDK8
Swiss HAT
The Impact of Heroin Prescription on Heroin Markets in Switzerland by Martin Kiillias and Marcelo F . Aebi Crime Prevention Studies, volume 11, pp. 83-99 (2000)
http://www.popcenter.org/library/crimeprevention/volume_11/
The Swiss heroin prescription program was targeted at hard-core drug users with very well established heroin habits. These people were heavily engaged in both drug dealing and other forms of crime.
• It substantially reduced the consumption among the heaviest users, and this reduction in demand affected the viability of the market.
• It reduced levels of other criminal activity associated with the market.
• By removing local addicts and dealers, Swiss casual users found it difficult to make contact with sellers.
Swiss programme
Heroin Assisted Treatment –systematic review
http://www.emcdda.europa.eu/publications/insights/heroin-assisted-treatment
http://www.youtube.com/watch?feature=player_embedded&v=3KxldfcQlQE#t=80Watch to 4:06
Importance of harm reduction
‘given the frequent contact between drug users and criminal justice systems, and ongoing epidemics of blood-borne viruses linked to problem drug use, there is an urgent need for harm reduction services to be scaled-up’
EMCDDA 2010 (p.394) Harm reduction: evidence, impacts and challenges
Chapter 14 by Alex Stevens, Heino Stöver and Cinzia Brentari ‘Criminal justice approaches to harm reduction in Europe’ see http://www.academia.edu/2835065/Criminal_justice_approaches_to_harm_reduction_in_Europe
A review of the evidence-base for harm reduction approaches to drug use by Neil
Hunt
In essence, harm reduction refers to policies and programmes that aim to reduce the harms associated with the use of drugs.
A defining feature is their focus on the prevention of drug-related harm rather than the prevention of drug use per se. One widely-cited conception of harm reduction distinguishes harm at different levels – individual, community and societal - and of different types - health, social and economic (Newcombe 1992).
These distinctions give a good indication of the breadth of focus and concern within harm reduction.
Document URL: http://www.forward-thinking-on-drugs.org/review2-print.html
Harm Reduction Approach: MALAYSIA
http://www.aljazeera.com/video/asia-pacific/2011/11/201111308512277302.html
Harm Reduction complemented by
Motivational Interviewing and the
Cycle of Change
an effective approach for any habit or learnt
behaviour
Harm Reduction utilising Millar & RollnicksMotivational Interviewing
and Prochaska & Di Clemente’sCycle of Change
32
Cycle of Change Prochaska, Di Clemente & Norcross (1992)
Maintenance
PreContemplation
Termination
Action Preparation
ContemplationRELAPSE
33
Motivational Interviewing
‘directive and client controlled’. (Rollnick and Miller 1995)
Aims to elicit behaviour change by ‘helping clients to explore and resolve ambivalence’ (Peterson and Mc Bride, 2002).
‘Is only a prelude to treatment; it creates openness to change, which paves the way for further important therapeutic work’ (Goodman, 2007)
Goldberg, T. 1999, Demystifying drugs: A psychosocial perspective, Macmillan Press, London
Harm Reduction Case Study
Katie is young single parent mother aged 22 years old who has two children aged 18 months and 4 years old.
Afraid of losing her children she keeps her 4 years drug habit a secret.
She currently injects street drugs using needles she gets from a friend after she’s used them. After she has used her needles she hides them carefully in a bag which she puts in the bin.
She finances her habit mainly by shoplifting and sex work, but she is increasingly in debt. She says she uses mainly at night when the kids are in bed.
She also worried because she thinks she might be pregnant.
What can be done to reduce harm
Harm Reduction MatrixA = Severe; B= Moderate; C = Low
Newcombe, R. (1992) The reduction of drug related harm: a conceptual framework for theory, practice and research. In, O.Hare et al (Eds.) The reduction of drug related
harm. London Routledge.
Harm Reduction: Conflicts with CJS
‘Contradictions that hinder the effort to reduce harm through the criminal justice system. The first is the fact that criminal justice systems themselves produce harms. …arrests, fines, community penalties, imprisonment and parole all infringe on individual freedoms and pleasures.
Countries do not use prison as a direct, rational measure to reduce crime. Rather, they choose — through a complex process of ideological, moral, political and juridical negotiation — the level of pain that they are willing to inflict on their citizens (Christie 1982). If we choose the level of harm that we inflict, we can also choose to reduce it.’ (p.380)
Stevens A., Stover, H. & Brentari, C. (2010) Criminal justice Approaches to Harm Reduction in Europe, pp379-402 in EMCDDA, Harm reduction: evidence, impacts and challenges EMCDDA, Lisbon, April 2010 On Blackboard
Issues with Treatment in the CJS
The second contradiction in pursuing harm reduction in the criminal justice system is that between the pursuit of abstinence and the acknowledgement of continuing drug use. Countries are obliged, through the UN drug conventions, to prohibit and to penalise the possession of certain substances.
The criminal justice system is the process that puts these obligations into practice. It is very difficult for the same system to acknowledge that the people under its control continue to defy the law. (p.380)
Stevens A., Stover, H. & Brentari, C. 2010 Criminal justice Approaches to Harm Reduction in Europe, pp379-402 in EMCDDA, Harm reduction: evidence, impacts and challenges EMCDDA, Lisbon, April 2010
Coercive Benefits Both drug courts and ‘coerced abstinence’ interventions deploy frequent
monitoring and chemical tests with the threat of graduated penal sanctions to deter re-initiating drug use and to reduce the probability of more serious offending and subsequent criminal sanctions.
Other enforcement measures may also have promise. Stricter controls on precursor chemicals appear to have at least short-term effects on methamphetamine consumption (Cunningham & Liu 2003). Work-place testing is argued by some to have led to reductions in adult drug use, by threatening job loss (Frenchet al. 2004). Evaluations of school testing programs provide hints that these, too, might reduce adolescent substance use. (p.351) [my emphasis]
Addiction: 101 341-347 (March 2006)
How much can treatment reduce national drug Problems? Peter Reuter & Harold Pollack School of Public Policy, University of Maryland and the RAND Corporation, CA, USA and School of Social Service Administration, University of Chicago, IL, USA
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