This commentary is by Ed Baker of Burlington, a master’s-level social worker and activist who has worked in addiction health in Vermont since 1985. He hosts and produces the Addiction Recovery Channel and is in personal recovery for 38 years.
Since the beginning of the “War on Drugs” in America, we’ve all been taught that an “addict has to hit bottom before he will get motivated to seek help and change.”
Bottom consists of being unhoused, unemployed, unfed, unwanted, miserable and confused, very often with mental health, medical and/or legal complications. You could call it despair.
What happens in America when the “addict hits bottom” is directly reflective of an entrenched war-on-drugs ethos where people who use drugs, at their “bottom,” are punished, prosecuted, coerced and judged. Stigma pounces on them. They are treated harshly, blamed, and seen as less.
The last vestige of a flickering sense of self-worth is often assaulted. It happens sometimes subtly, as in a caregiver’s tone, facial expression and body language signaling judgment or condemnation. Or not so subtly, as in being searched, handcuffed, arrested, charged with possession of an illegal drug and incarcerated.
Is it any wonder a person with addiction learns to avoid our care systems? Believe it or not, they are protecting themselves.
Nora Volkow, director of the National Institutes on Drugs and Addiction, eloquently tells the story of a person with addiction in Puerto Rico with infectious sores threatening the amputation of a limb. The person refuses health care out of fear of the harsh indignity of stigma, protecting his flickering sense of self-worth.
While the darkened doorways of back alleys were once the hiding places for people such as this with addiction, waiting to die, today the uncared-for and unhoused are more than visible. The back alleys cannot contain them any longer. We see them every day and we turn away while we passively support systems still waging a deadly war against them. Systems with policies that exclude the most at-risk for death.
It’s not working.
People are “hitting bottom” and are suspended there, abandoned by a system so poorly designed it alienates them instead of helping them.
They need to “hit safety.”
What would it be like if something I’d like to call “unconditional safety” replaced stigma and was offered to people at this point in their life — was offered to people with addiction at their time of despair?
Unconditional safety springs from the inner world of the other. It’s the sheer absence of punitive judgment, rigid demand, the many faces of stigma. It is acceptance, genuine and unmistakable. It does not demand, judge, prosecute or place conditions on the relationship. It is truly interested in who you are, your experience. It meets you there, where you are emotionally, and with high regard accepts you.
It waits for you to indicate your request for assistance of some kind. It supports you moving forward in the way you feel is important to you. It sticks with you in your process no matter what.
In our world, it’s called harm reduction. It’s meeting you where you are and not leaving you there: neutral on using drugs, negative on harm, positive on change. Change defined by you.
Harm reduction rests on absolute respect for the person’s right to self-determination. This is coupled with a very finely tuned readiness to hear glimmers of motivation toward positive change as defined by the person. Harm reduction is a comprehensive engagement process marked by the absence of threat. It is the beginning of a process determined and defined by the person using drugs. It is, above all, safe — and it works.
Vermont has embraced harm reduction and begun a new era in its response to people who use drugs. A foundation determined by advocacy, science and compassion has been laid by our state Legislature’s crafting of H.222, an act relating to reducing overdoses, signed into law by Gov. Scott on May 25, 2023.
Bravo to the advocates!
Although this structure and its components are a significant step forward, and there is reason to believe our health care system will be more responsive and therefore more effective, especially in preventing accidental drug overdose, this foundation is but a foundation.
There will be much to accomplish going forward if we are to create a system of care that is firmly based in science and clearly motivated by compassion. Help without love is not help; justice without love is not justice.
The next obvious step for Vermont is the creation of a system of overdose prevention centers scaled to our needs: fixed sites, mobile units, and virtual support. These interventions are medically necessary, supported by research, and Vermont has the resources at its disposal to fund them. There is both overwhelming need and matching political and community support for an overdose prevention center in Chittenden County, presently losing at least one community member a week to accidental drug overdose death.
With our continued advocacy and the support of Vermont’s governor and Department of Health, this next step can become a reality.
