Harm reduction proponents often profess that their approach has ‘roots in humanitarianism and libertarianism’ (Newcombe 1992: 1), which place primary emphasis on individual liberty and individualism, yet there is also a tendency by many of them to adhere to social justice ideology (Pauly 2008; Friedman 1998; Graham 2014) which inherently favours collectivist values and epistemology. For example, groups like the Harm Reduction Coalition identify as a ‘movement for social justice’ (Greig & Kershnar 2002: 365). Social justice can be defined a position that aims for the eradication of all forms of social oppression, inequality and, frequently, for one form or other of economic redistribution (Feagin 2001). A harm reduction approach that is informed both by a collectivist value of a social justice orientation and the individualist values of libertarianism can become internally inconsistent.
There can be detrimental consequences when harm reduction policies are geared towards collectivist instead of individualist aims. The influence of social justice activists has moved the aim of harm reduction away from helping the individual towards that of the ‘common good’. Mugford (1993) points to the self-contradictory nature of harm reduction’s adherence to its utilitarianism (informed by collectivist values, through which Draconian anti-Drug strategies have been defended) and its liberal values (based on humanistic and libertarian perspectives, the protection of civil liberties and human rights). Miller’s (2001) view is that the primary impulses of harm reduction programmes have not been out of concern for the individual drug user, but rather for the benefit or protection of the ‘general public’ and the reduction of health care costs. Indeed, for some harm reduction organisations and activist groups, syringe exchange is merely a means to an end, a political activity and not a value-neutral healthcare intervention. In extreme cases, harm reduction threatens to become a ‘holy cause’, a kind of mirror to the moral righteousness behind the politics driving the ‘war against drugs’. As Eric Hoffer, author of The True Believer (1951) reminds us
The burning conviction that we have a holy duty toward others is often a way of attaching our drowning selves to a passing raft. What looks like giving a hand is often a holding on for dear life. Take away our holy duties and you leave our lives puny and meaningless. There is no doubt that in exchanging a self-centred for a selfless life we gain enormously in self-esteem. The vanity of the selfless, even those who practice utmost humility, is boundless (p. 23).
The bias of an overly collectivist approach to addiction is also exemplified in research, where nearly all attention has focused on indicators of change that are observable and socially desirable (e.g., abstaining from drugs, avoiding criminal activity, gainful employment). It frequently neglects other, more functional, indicators (e.g. quality of life, satisfaction with treatment) that bear more importance to drug users themselves (Fischer et al 2001). And, perhaps most crucially, rarely have studies explored the congruence of these outcomes with the perspectives of drug users (Fischer et al 2001). The currently available instruments (e.g. the generic Nottingham Health Profile) were developed for and by professionals without input from drug users or their families and caregivers (Fischer et al 2001). Their viewpoints are notably missing from the literature (Drumm et al 2003). According to Saleebey (1996: 301) oppressed or marginalised populations typically have ‘[their] stories buried under the forces of ignorance and stereotype.’ In the context of this essay, I would argue that drug users often have ‘their stories buried under the forces of ignorance and stereotype’ (Saleebey, 1996: 301) of collectivist thinking.
Harm reduction approaches should not be driven by political agendas, and we do not need more ‘true believers’. Social justice activism is a political project and not an evidence-based scientific activity, and it is concerning how social justice-orientated harm reduction proponents assume the self-evident truth of this position, considering the complex philosophical or political debates and critiques that underpin collectivist ideology (see Strang 1993, Psychoactive drugs and harm reduction: From faith to science). Instead, we require the perspectives of people who identify as addicts, empirical research, clinical experience, concern for drug users as individuals and pragmatic health aims.
References to be found in: Du Plessis, G. P. (in Press) Some Incompatible Knots in Harm Reduction, in Let’s Talk About Opioids and Harm Reduction in South Africa. HSRC Press (Edited Volume).