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Author: Nigel Brunsdon

Trauma-Informed

Written by Nigel Brunsdon on . Posted in Philosophical Orientations.

The term “trauma-informed” emerges from a growing understanding of the far reaching ways that trauma impacts health and well-being. Trauma is defined here, in keeping with the scientific literature, as a deeply distressing or disturbing experience(s) that overwhelms an individual’s ability to cope, and significantly impacts their mental, emotional, and physical well-being. Trauma has hallmark brain activity, including an overwhelming response, and hyperactivity, in the amygdala.

The amygdala helps with essential functions such as detecting and responding to threats, encoding emotional memories, and regulating emotional responses, and is fully activated during traumatic events. Trauma can result from a single event or from prolonged exposure to adverse conditions. The effects of prolonged exposure to stress hormones activated by trauma can be pervasive and long-lasting, and includes greater risk of depression, anxiety, chaotic substance use, unstable relationships, unstable work lives, and many poor physical health outcomes like increased risks for high blood pressure, heart disease, cancer, diabetes, etc.

“Trauma-informed” has emerged as language to describe the ways that service providers must adopt a mindset and approach that prioritizes understanding, empathy, and support for those who have experienced trauma. It involves creating environments and practices that promote safety, trust, and healing, while recognizing and addressing the complex effects of trauma on individuals and communities.

Ideally this means understanding that the population you serve is in need of:

  • Safety
  • People Who Are Trustworthy and Transparent
  • Peer Support
  • Collaboration and Mutuality
  • Empowerment and Choice
  • Recognition of Structural Inequalities

In practice this means:

  • Understanding trauma and its impact: Recognizing that trauma can result from various experiences, including violence, abuse, neglect, extreme poverty, incarceration, and systemic oppression.
  • Understanding the broad impact trauma can have on mental, emotional, and physical health.
  • Recognizing signs and symptoms: Being able to identify key signs and physiological symptoms of trauma in participants and others.
  • Integrating trauma knowledge into practices: Applying knowledge about trauma into policies, procedures, and practices. This means adopting strategies that minimize the risk of re-traumatization and that promote healing and recovery.
  • Resisting re-traumatization: Actively working to avoid practices and behaviors that could re-traumatize individuals. This involves being mindful of triggers and creating a supportive environment that minimizes re-traumatization and maximizes building trust and community.

Restorative and Transformative Justice

Written by Nigel Brunsdon on . Posted in Philosophical Orientations.

The restorative and transformative justice movements are two other sibling movements of the harm reduction movement, like the sex positive movement, that produced the idea of consent culture. Similar to the sex positive movement, the restorative and transformative justice movements share a lot of the same premises of harm reduction, such as a deep respect for personal autonomy, a lack of belief in overly simplistic responses to complex behavior and conflicting motivations, and a fundamental examination and critical analysis of the intersections in which that behavior takes place.

The basic tenets of restorative and transformative justice are very much the same. They both:

  • Are based in peace studies and critical theory as well as other schools of thought,
  • Center the victim or survivor on all levels of the response,
  • Require the consent of all parties,
  • Address root causes and structural harms such as poverty, class, racism, social isolation, past trauma, sex-based discrimination and other social inequalities.

They focus on:

  • Accountability, not punishment,
  • Dialog and storytelling,
  • All stakeholders,
  • Community connection and restoration,
  • Preventing future harms,
  • Empowering all stakeholders, including perpetrators, and
  • Sustainability/long-term outcomes.

However, where restorative justice aims to repair harm and restore relationships within the existing social framework, transformative justice seeks to fundamentally change the conditions that lead to harm, promoting broader social transformation and systemic change—which is why it is considered more in-line in some ways with harm reduction. Nonetheless, restorative justice practices have been around for much longer and have had many more opportunities to be tested in real life situations, so there is, at this time, far more evidence to support restorative justice, and it is robust.

Some examples of evidence-based practices include victim-offender mediation programs, restorative circles in schools, restorative justice in carceral situations, community restorative boards, and many truth and reconciliation efforts.

The organization Philly Stands Up addresses sexual assault and other forms of harm through community-based accountability processes. This is one example of a transformative justice project. Just Practice and the Resisting Criminalization Help Desk, where movement builders and community members can get help building strategies to address violence in their communities more effectively without the police, are two others.

Consent Culture

Written by Nigel Brunsdon on . Posted in Philosophical Orientations.

The concept of “consent culture” emerged from the sex positive movement of the 1980s and 90s. It was a response to the concept of “rape culture”, a term that had been coined to describe the experience that many people—especially women, queer and trans people—have of sexual violence and harassment. Consent culture aims to create a society where mutual respect, communication, and consent are the norms in all interactions. This concept has also been applied to current training approaches around sexual health and sexuality.

The idea of consent culture is fundamental to harm reduction in many ways because harm reduction, like consent culture, is based on the idea that every person is an autonomous individual who should have complete control over their own body. This pertains obviously to sexual activity, but it also pertains to drug use. Consent culture also maintains the idea that people retain the ability to give or retract consent at any time during any interaction. Harm reduction equally maintains the idea that people retain the right to give or retract consent to services, to drug use, and/or to other behavior.

One model of consent that is quite popular is “CRISP”. CRISP (C=Considered, R=Reversible, I=Informed, S=Specific, P=Participatory) is an acronym that embodies the fundamentals of consent culture.

CRISP asserts that consent should be Considered, and that the individual considers their choices and understands that they’re making a choice; that the choice be Reversible—meaning that they can at any time retract consent; Informed—meaning that they understand the choices they’re making and the consequences of them; Specific—meaning that it’s specific to their circumstance and not in general; and finally Participatory—which means that they enthusiastically participate and aren’t just passively giving in to a behavior or activity.

Principles of Harm Reduction

Written by Nigel Brunsdon on . Posted in Philosophical Orientations.

These principles were developed over a period of about four years in the 1990s amid much debate among early harm reductionists, who came to consensus on these enduring principles of harm reduction:

  • Accepts, for better and for worse, that licit and illicit drug use is part of our world, and chooses to work to minimize its harmful effects rather than simply ignore or condemn them.
  • Understands drug use as a complex, multi-faceted phenomenon that encompasses a continuum of behaviors from severe abuse to total abstinence, and acknowledges that some ways of using drugs are clearly safer than others.
  • Establishes quality of individual and community life and well-being—not necessarily cessation of all drug use—as the criteria for successful interventions and policies.
  • Calls for the non-judgmental, non-coercive provision of services and resources to people who use drugs and the communities in which they live in order to assist them in reducing attendant harm.
  • Ensures that drug users and those with a history of drug use routinely have a real voice in the creation of programs and policies designed to serve them.
  • Affirms drug users themselves as the primary agents of reducing the harms of their drug use and seeks to empower users to share information and support each other in strategies which meet their actual conditions of use.
  • Recognizes that the realities of poverty, class, racism, social isolation, past trauma, sex-based discrimination, and other social inequalities affect both people’s vulnerability to, and capacity for, effectively dealing with drug-related harm.
  • Does not attempt to minimize or ignore the real and tragic harm and danger associated with licit and illicit drug use.

Harm Reduction Working Group, published 1997

Harm Reduction

Written by Nigel Brunsdon on . Posted in Philosophical Orientations.

Harm reduction and its principles are obviously the basis for all the Hacks. Though harm reduction is not a philosophy per se and draws from sources like psychology, science, feminism, egalitarianism, humanism, and queer and critical theory, harm reduction is about radical pragmatism around high-risk behaviors as well as a deep and compassionate understanding of social location, and the barriers faced by stigmatized people like folks struggling with their substance use, people who do sex work, and unhoused people. Harm reduction shares many traits including:

…being in favor of ANY positive change, as defined by the person making the change.

…“meeting people where they are at,” and letting them tell you where that is.

…not minimizing or exaggerating the dangers of risky behavior.

…being realistic, pragmatic, and evidence-based.

…embracing ambiguity and gray.

…being founded on compassion and respect for individual autonomy and agency.

…assuming positive intent and personal capacity.

…seeing people, and their risky behavior, holistically and contextually.

…being honest about the real and often terrible consequences of drug use as well as its benefits.

…not being punitive, yet holding people accountable for their impact.

Other Notes on Language

Written by Nigel Brunsdon on . Posted in Language.

Throughout Space Hacks, we build on the foundations laid by the original Harm Reduction Hacks by using a shared language. This includes key definitions and concepts that support a consistent, inclusive, and grounded approach to harm reduction, social justice, and health equity. Below you’ll find brief explanations of the terms and ideas used throughout the project.

  • Uses and defines “social location” as “the social position an individual holds within their society, based upon social characteristics deemed to be important by any given society.” Some of the social characteristics deemed to be important in the US include economic and social class, race, gender, sexual orientation, ethnicity, religion, physical ability, age, regional origin, and appearance.
  • Uses and defines “structural violence” as “the multiple ways in which social, economic, and political systems expose some groups to disproportionate risks and vulnerabilities leading to increased morbidity and mortality.” Those systems include income inequality, racism, classism, homophobia, sexism, ageism, ableism, lookism, and other means of social exclusion leading to increased vulnerabilities, such as poverty, stress, trauma, mental illness, substance misuse, crime, incarceration, and lack of access to care, healthy food, and physical activity.
  • Uses and defines “cultural humility” as “the ability to maintain an interpersonal stance that is other-oriented and open to others in relation to aspects of cultural identity that are most important to the other person.”
  • Uses and defines “cultural competency” as “the ability to understand, appreciate and interact with people from cultures or belief systems different from one’s own.”
  • Uses and defines “drug use” as “a complex, multi-faceted phenomenon that encompasses a continuum of behaviors from intense chaos to complete functionality and acknowledges that some ways of using drugs are clearly safer than others.”
  • Uses and defines “peer-reviewed evidence” as “research that has been evaluated and critiqued by researchers and experts in the same field before the information is published.”
  • Occasionally uses the phrase “proximate community members” to mean all of the friends, loved ones, and neighbors who may not use drugs, to whom harm reduction programs provide services in addition to people who use drugs.

Important Terms: Person First Language

Written by Nigel Brunsdon on . Posted in Language.

Generally, it’s important to use “person first language” when describing people who are marginalized due to some part of their identity being stigmatized, such as folks struggling with their substance use, people who do sex work, and folks living outside.

Person-first language originates in the mental health consumer rights movement—a push by folks receiving psychiatric care to de-stigmatize and gain rights for mental healthcare consumers.

Person first language was initially developed because people with psychiatric conditions were previously described by clinicians solely in terms of those conditions. Mental health consumers wanted it acknowledged that no matter what people are dealing with, they are still a person before their label, and they deserve dignity, recognition, empathy, and respect.

“Addict” is also a word with immense negative connotations for many. Though the term is supposed to be clinical, if most of us are honest we have heard the term used, often alongside a drug, to explain misconduct or antisocial behavior—as if the problem creates that behavior—even though most of us also know people who use drugs who don’t behave in those ways.

There are also studies showing that using “addict”,” and even more pejorative language like “methhead” or “crackhead,” leads to folks getting dehumanized, reduced to their struggle, mistreated, and, of course, helps ensure they are then far less likely to move forward in change.

The term “addict”—though we acknowledge it is proudly reclaimed by many who feel like the word is an identity that they need to own for themselves—also feels to some people as though it reduces them to one facet of their lives and disconnects them further from other people, making change harder.

So, instead of calling someone an “addict”, Space Hacks will sometimes use the term “person or people who use(s) drugs (PWUD)” because we strongly believe that people who use drugs are, first and foremost, human beings who deserve dignity, recognition, empathy, and respect.

Finally, we would be remiss if we didn’t mention that some folks in the community have expressed a strong preference for people to use the phrase “people who use drugs”, rather than the acronym, PWUD—which we use in writing—in live conversation.

The Problem with PWUD: SUD and OUD vs. Chaotic Drug Use

One of the problems that arises with the term “people who use drugs” is that it is intentionally pluralistic in its embrace of ALL people who use drugs—from recreationally to deeply problematically. This makes using it to talk about the things that especially impact people who are using drugs problematically very difficult.

In light of that, and because this work is based on the Principles of Harm Reduction, throughout this document the phrases “chaotic drug use,” “person using chaotically,” and “problematic substance use,” will be used instead of “addict” or clinical terms gaining currency such as substance use disorder (SUD) and opioid use disorder (OUD).

The term “chaotic drug use” is based on a model of problematic drug use created by pioneering harm reductionists Dr. Patt Denning PsyD and Jeannie Little in their groundbreaking book “Over the Influence”.

They created this model because it has become clear from the literature, and the lived experience of drug users, that drug use is more like a continuum that ranges from complete abstinence to recreational use to total chaos.

This continuum model refrains from using the stigmatizing and binary language of “addiction,” with preference for the more accurate description of drug use as a relationship continuum from functional to chaotic, and people who use drugs as physically dependent or not.

This model acknowledges that folks use drugs for many different reasons ranging from spiritual to pathological, and concedes that people’s relationship with drugs depends on a variety of variables including physical health, emotional health, trauma history, age, and many others.

Finally, the harm reduction continuum model acknowledges that people’s use is naturally variable over time—not necessarily on a trajectory toward death. Since drug use is a continuum, we focus on the relationship that people have with their substances of choice at any given time.

Important Terms: Escalated Events

Written by Nigel Brunsdon on . Posted in Language.

Rather than refer to “emergencies” or “security problems,” we talk in terms of “escalated events,” because all of the following can create escalated emotional states, and sometimes catastrophically heightened stress levels, in everyone involved. They also have the potential to do a great deal of harm to the people and organizations they touch. But many of the things that help prevent and respond to all of them are the same—despite very different variables.

  • Any kind of violent event or threats of violence
  • Medical emergencies
  • Severe emotional or perceptual issues or dysregulation
  • Disasters
  • Accidents
  • Overdose
  • Sudden and/or catastrophic loss

Acronyms First

Written by Nigel Brunsdon on . Posted in Language.

This website uses a number of commonly recognised acronyms related to harm reduction, health services, and drug policy. To help you navigate the content more easily, we’ve compiled a quick-reference list of these terms and their meanings.

  • CDC – Centers for Disease Control and Prevention
  • FQHC – Federally Qualified Health Center
  • FSHRP – Fixed-Site Harm Reduction Program
  • FSSSP – Fixed-Site Syringe Services Program
  • HRHD – Harm Reduction Home Delivery
  • MAT – Medication Assisted Treatment
  • MHRS – Mobile Harm Reduction Services
  • OPS – Overdose Prevention Site.
  • OUD – Opioid Use Disorder
  • SAMHSA – Substance Abuse and Mental Health Services Administration
  • SSP – Syringe Service Provider
  • SUD – Substance Use Disorder