1. Addictions Policymaking in Canada: The Role of Harm Reduction Gerald Thomas Senior Policy Analyst CCSA

2. Quotes to Consider  Insanity can be defined as doing the same thing over and over again and expecting different results each time. -Albert Einstein  No device or plan of the mind will ever solve a crisis of the heart. - Tatananayaho, Native Shaman

3. Outline  The Policy Cycle and Kingdon’s Model of Agenda Setting  Problem: The Determinants of Health  Policies: The Four Pillars  Politics: Unproductive Polarization in the Drug Policy Debate  The Role of Harm Reduction

4. The Policy Cycle Agenda Setting Policy Formulation Policy Legitimation Policy Implementation Policy Evaluation

5. Kingdon’s Model of Agenda Setting  Kingdon envisioned the agenda setting process as consisting of three “streams:” Problems Problems Policies (solutions) Policies (solutions) Politics Politics  His model posits that each of these streams follows their own dynamics and that events and people bring them together to create “windows” that can bring an issue to the formal agenda of government.  Kingdon also suggested that often times policymaking is more a matter of people applying their pet solutions to social problems within a topsy turvy political environment than some sort of orderly, rational approach to problem solving.

6. Problem  There is plenty of evidence that addiction is a major problem: Social Costs of at least $40B year.  So, what causes addiction?  My favorite explanation for why people develop substance abuse problems is based on a wholistic “determinants of health” approach with the determinants drawn from four categories: Biological (genetics) Biological (genetics) Psychological (mental health) Psychological (mental health) Social (enculturation, marginalization, economics, etc.) Social (enculturation, marginalization, economics, etc.) Spiritual (???) Spiritual (???)

7. Problem (cont.)  The Public Health Agency of Canada identifies 9 “social” determinants of health:  income inequality  social inclusion and exclusion  employment and job security  working conditions  contribution of the social economy  early childhood care  education  food security  housing

8. Policies  One way to conceptualize possible responses to substance abuse is by the four pillars approach: Prevention Prevention Treatment Treatment Enforcement Enforcement Harm Reduction Harm Reduction  Historically speaking, we have tended to emphasize enforcement over treatment and prevention.  Harm reduction is a relative new comer in our response to addiction.  One issue that weaves through all of these is our attitude toward the addicted individual.  This attitude plays a big role in determining one’s “preferred” responses (think back to Kingdon’s model).

9. Politics  The realm of substance abuse policy is fraught with political controversy.  This controversy has created a split between those who view substance abuse as primarily an enforcement issue and those who view it as a health issue.  In reality, it is both and more if we can go back to the bio-psycho-social-spiritual determinants of health as the cause of addictions.  Illness metaphor.  Einstein quote.

10. The Role for Harm Reduction  To me the best part about the HR approach is that it gets past the judgments that sit behind the unhelpful schism between the enforcers and the health folks on the substance abuse issue.  What I have discovered is that it is very hard to look honestly at oneself and affect meaningful and lasting change when we are feeling judged.  A non-judgmental approach creates openings for people to look at themselves honestly and deal with the root causes of their addiction.

11. Harm Reduction (cont.)  Those preferring to view addiction as a problem of individual choice and weaknesses often say: well, if someone wants to use drugs why should my tax dollars go into trying to help them?  This is an argument often brought forward to argue against funding harm reduction programs.  What is misses is that this person is paying for the enforcement responses anyway.  And, more importantly, that society as a whole must take some responsibility for allowing a subset of its members to fall through the cracks. Marginalization is real and can have serious negative effects on people’s ability to function in the world.  This is a more mature and compassionate approach that is possible when one embraces the wholistic bio-psycho-social- spiritual determinants of health approach.

12. Harm Reduction (cont.)  As well, I think we have to allow that there are some folks who’s bio-psycho-social-spiritual system makes it very difficult for them to not abuse substances.  In these instances, the best choice may be to apply policies and programs that minimize harms to the individual and costs to society without being too focused on making them end their substance use.  Example: managed alcohol program in Ottawa.

13. Harm Reduction (cont.)  Where harm reductionists fall down, I believe, is when they does not place reasonable boundaries around the approach itself.  It is not true that we should forego all enforcement activities as they do play a role in limiting the availability of substances of abuse and this can and does contribute to the level of problems with substances.  However, when we over emphasize enforcement at the cost of other approaches, and instill a lot of social judgment in this process, we are actually making it harder for people to do the deep healing work necessary for real growth and change.

14. A Plug for the Spiritual  When looking at the determinants of addiction (biological, psychological, social and spiritual) it is clear to me that the spiritual really gets the short end of the stick.  This is a function of the move toward “hyper-rationality” in the modern world.  Science gives us a method for studying reality systematically but it should not tell you what to study.  You can study your soul systematically and this is exactly what native cultures understood.  This is why Colleen’s work to bring the native perspective into the world of addictions is so very important.

15. Questions?