does language matter?
Different perspectives drew a very visible
line between language and stigma
S
peakers at Hit Hot Topics
covered many areas of harm
reduction, drug use and
outreach, and their experience
came from different countries and
contexts. But there was a common
theme that ran through each of their
talks – the ‘dehumanising language’
that perpetuated stigma.
Professor Susanne MacGregor of the
London School of Hygiene and Tropical
Medicine charted 30 years of drug
interventions. Throughout ‘many
contextual changes, during which harm
reduction has had to struggle’, language
had been adapted and new terms
introduced. The New Labour era, ‘tough
on crime and the causes of crime’, gave
way to ‘the language of recovery’. Gaps
grew between those who provided
services and the people that used them.
‘Let’s stop using derogatory
descriptions of people and move to a
society where rights and evidence
prevail,’ said Naomi Burke-Shyne, Harm
Reduction International’s deputy
director, in her talk about the oppressive
impact of drug policy on science.
‘We can’t affor d to abandon
evidence, and language is a big part of
that,’ she said. ‘We can’t use
stigmatising language. Let’s stop
talking about abuse – it implies all use
is abuse.’ There were words that were
formerly used about the LGBT
HARRY SHAPIRO
www.drinkanddrugsnews.com
community that were ‘unspeakable
today’, she pointed out, adding ‘we
need to move the same way’.
Prof Craig Reinarman of the
University of California talked about
drug policy reform and the ‘slow
motion shift’ in the way we think about
people who use drugs. Back in the
1980s, as initiatives spread from
Liverpool like a ‘crack in the stone wall
of punitive prohibition’, the very words
harm reduction were ‘blasphemy, giving
the stamp of control to addiction’.
Similarly, in the US, scientists ‘couldn’t
even use harm reduction in the title of
a paper’ for it to be accepted.
Drug terminology became the
language of fear: ‘Crack cocaine is the
principle cause of urban ghettos’,
President Reagan’s drug czar William
Bennett had said in the 1980s. Even
now, 40 years later, discussions take
place ‘in a different register’ for
different parts of the population. White
people find treatment beds waiting, not
prison cells, said Reinarman.
Delon Human of Health Diplomats,
Switzerland, found dialogue missing
where tobacco harm reduction was
concerned. Of the earth’s 7bn
population, 1.4bn were smokers and
one out of two smokers would have a
condition that would limit their life. In
the UK e-cigs were resulting in the
number of smokers being ‘the lowest
JENNIFER RANDALL
STEPHEN MALLOY
it’s ever been’, with the ‘biggest gains in
the shortest time’, yet public health
seemed unwilling to talk frankly about
the benefits.
‘We can all accept seatbelts, but for
some reason they’re not accepted in
drugs and alcohol,’ he said. ‘We need to
find new language to frame the debate’.
Stephen Malloy of the European
Network of People Who Use Drugs
(EuroNPUD) called for plain language to
galvanise the pace of a harm reduction
response to drugs such as fentanyl,
whose dangers were well known and
documented. This was an example of
direct action needing to be
accompanied by straight talking, he
said, quoting the Canadian activists’
slogan ‘they talk, we die’.
For Patriic Gayle of the Gay Men’s
Health Collective, harm reduction was
being compromised because the
conversation between gay men and
drug workers was ‘conspicuous by its
absence’. Back in the ’80s, the LGBT
community and substance misuse field
came together to make sure Aids
campaigning was as hard-hitting as it
could be, but the dialogue had
disappeared. Gay men ‘need to be
engaged and wooed a bit to trust
services,’ he said, and his organisation
had had to resort to distributing
resources and information that spoke
honestly and openly to peers.
In a similar context, Joseph Kean,
visiting research fellow at LJMU, looked
at the language and culture of image
and performance enhancing drugs
(IPEDs) and asked, do we have relatable
ways of reaching the ‘massively
underestimated’ 70,000 people using
these drugs?
CRAIG REINARMAN
DrugWise’s director Harry Shapiro
felt that disconnection was abetted by
the terminology we chose, and that
drug workers must take a share of
responsibility for perpetuating stigma
through using ‘a language of hate’,
which made people who use drugs feel
‘expendable’.
‘It resides within the community
and the drug sector to challenge it,’ he
said. ‘I don’t use addict, clean, drug
abuse or misuse.’
Teaching a university course on
personal and professional development,
Dr Jennifer Randall had had the
opportunity of exploring the triggers to
attitude change. Introducing students to
the Support, Don’t Punish campaign, she
witnessed how they embraced a Gabor
Maté approach – ‘think of people with
love’ and had insight into creating the
right language to change culture. Using
Dr Carl Hart’s book, High Price, she
encouraged ‘slow critical conversations’
that were effective in changing
students’ attitudes and preconceptions.
The final speaker, Emma Roberts,
demonstrated the value of making
grassroots user-led initiatives the
mouthpiece, putting them at the
forefront of commissioning and
capacity building. Through describing
her work with the Harm Reduction
Coalition in the US, she explained that
the voice of people who used drugs was
vital, not just in leading advocacy, but
in choosing the right language and
setting the tone. Working with different
drug user alliances she was able to
challenge stigma and redefine recovery,
demonstrating that ‘it is not the opposite
of harm reduction’, but all part of the
same necessary conversation. DDN
SUSANNE MACGREGOR
December/January 2018 | drinkanddrugsnews | 9