I believe that drug use and drug treatment have many more levels than the ones we usually hear about or focus on.
At a personal sphere, we can talk about physical, emotional, mental and spiritual levels. Besides the personal, we can also talk about a collective sphere, related to the local context of a particular person who uses drugs, but also to the wider surrounding culture (sub-cultures, regional, national or worldwide).
In this sense, when a person gets dependent on drugs, this is way more complex than saying someone got hooked on the drug itself and its chemical properties (physical). Or that people got into drugs for lacking a supportive family and/or a bigger purpose in life, or for making the wrong choices (emotional, spiritual, mental). It is also more complex than attributing dependence to “bad friends” or only to the lack of opportunities people had in life (context and culture).
Based on what I’ve heard and experienced so far, I believe drug dependence is a learned practice. One that some people might, indeed, be more prone to have, for various reasons involving the different levels above. But still, a practice that carries a good deal of free will, and thus, has the potential to be changed by focusing on personal choices.
In this journey to re-discover one’s self-conscious choices, developing a sense of belonging is one of the most important factors. I affirm that based on what I saw and heard from the hundreds of “drug workers” and “drug users” I’ve been talking to in the past 14 years in my professional life. The affirmation also resonates with personal experiences and those of people I met along the way.
The deal is: the sense of not belonging, of being a non-accepted outsider, it at the core of dependent practices. And so, investing on creating an (increased) sense of belonging and acceptance, is a powerful way to achieve self-awareness and control over dependent practices.
Belonging requires us to see and accept who we are, which can lead to meaningful connections not only with ourselves but also with others. Belonging is healing, in all levels.
Let me give you an example.
I was once driving with Mike, an outreach worker from a harm reduction program in South Africa. We were going through several open spots where people who inject drugs gather, to then deliver to them clean needles and other equipment for safe injecting.
As usual, users chose to gather at the most inhospitable places: under bridges, along river-sewage streams, small alleys, empty buildings, railways, wastelands… any place where they imagine the “good” or mainstream citizens wouldn’t bother going. Clearly, they were there to hide from the several judgmental community members, as well as from the police. There was a clear message in their choice: “we know we are not welcome at mainstream society’ s common places, so we stay outside”. Definitely, outreach workers like Mike had to gain these people’s trust before even being able to enter these areas. When facing an outsider trying to enter the area, the feeling of a possible threat tends to be greater than the feeling of possible help. Once bitten, twice shy.
At a certain point, siting at the back of the car while riding between one drug spot and another, Mike told me something that made my heart fill up with warmth and gratefulness for humankind.
Being an (ex) dependent drug injector himself, Mike believed the most important thing he does to the people he assists daily, is to care about them. Simple as that.
Not any type of care though, but a care that does not require someone to be or behave differently from whom they are to be accepted and cared for. A type welcoming, accepting, and humanized care.
Remembering of his days of heavy drug use and homelessness, Mike told me what has saved his life, and taken him out of the streets, was exactly this humanized care. When the harm reduction program started to reach the streets in South Africa, Mike (back then a dependent heroin user), suddenly saw himself being assisted by some people who cared about him. He told me he was surprised to see those outreaches cared enough about him to go to the dirty places he was gathering with others to offer them clean needles twice a week. More explicitly, in his words at the time, he was amazed by having “someone who gave a shit” to the person he was.
For the first time, Mike said, he felt belonging to something. Something that was extended to the outside of his drug using-group, expanding his boundaries of belonging.
As representatives of a health care association, the outreach workers who assisted Mike with clean needles and safe injecting information had accepted him as a drug-using person. Accepted and cared enough to search for him every week and to advise him to take better care of himself, while using his drugs.
New doors of perception opened up to Mike with that experience. Doors that led him to a beautiful path of increased self-care and self-acceptance. By receiving humanized care, Mike was able to look at himself and his body in a more caring way, thinking about potential harms, and gradually increasing the level of self-consciousness when making decisions on how and when to use his drugs of choice. Ultimately, Mike has become a harm reduction outreach worker himself. Having owned his drug using history and experience, Mike now uses it to help others to build new levels of self-care and belonging, as once it was done with him.
As you may imagine, Mike is not alone. His story repeats itself across South Africa and many other parts of the world. And the interesting thing is that not only people who use(d) drugs and later became drug workers describe belonging as such an important factor in drug dependence. In these 14 years studying drug policies and people who work with drug use, I had many workers telling me that a sense of belonging is (on of) the most important thing(s) they produce with their work. In the words of Linda, a Brazilian public health worker:
“… one of the first things that caught my attention when we started here [a psychosocial clinic for drug abuse] was how people effectively bonded with this place and the team. I think this mostly happens because people feel good here, they feel they are treated well, you know? They feel that here is a place where workers know their names, where they are respected […] and that creates bonding. I think the main thing we have achieved is to rescue the notion of subject… of person… [clients think:] ‘I’m not one more product of something, or, a drug addict, a beggar, a prostitute, you know? No, I’m a person, and I’m being looked in an integral way; I’m respected. Sometimes I can come dirty, sometimes I come starving, but everyone treats me like an equal. You know? There is a place to be me here’.”
A place “to be me” in Linda’s words, is a place or a condition where people who use drugs feel accepted by who they are. Without tough conditions or restrictions, but with mutual respect. When acceptance and belonging guide our practices with people who depend on drugs, we allow humanity to speak louder than judgement. And that produces fertile grounds for self-conscious choices to stand out as a human ability.
 I use fictitious names to protect people’s identities. Stories, though, are veridical.