Addictions in Uncertain Times

In Czech Republic, Dianova participated in a meeting of addiction professionals dedicated to the main challenges in this field

Uncertain times

The conference held in Czech Republic examined how uncertainty might worsen addiction and other mental health problems through its negative impact on affect and emotions, as well as the actions to be implemented to help people in vulnerable situations – Image: Shutterstock

On November 8 and 9, the town of Kutná Hora, in the Czech Republic, hosted its annual meeting on addictions, with the participation of many professionals. The theme of the meeting was the impact of uncertain times and current social issues on the addiction problem. The conference was attended by leading figures in the addiction field as well as representatives from government, public policies and civil society organizations.

The conference began with a presentation by Jindřich Vobořil, the Czech Republic’s national drug policy coordinator, on how current legislation and policies can directly affect treatment interventions.

This was followed by a presentation by Gisela Hansen, representing Dianova, entitled “Uncertain times and vulnerable groups: addressing addiction from an intersectional viewpoint”.

Intersectionality, vulnerability and uncertainty in the addiction field

In the context of research ethics, the ‘vulnerability’ concept applies to people identified as vulnerable and likely to benefit from care services going beyond that provided by regular institutions. Despite the support provided, one concern remains: the possibility that the fact of identifying certain groups or individuals as vulnerable may lead to paternalistic attitudes and stereotypes. In this sense, trying to protect vulnerable groups could do more harm than good, by attributing to them a form of ‘natural vulnerability’ while shifting the burden of responsibility onto the shoulders of those concerned.

Why does uncertainty have a particular impact on vulnerable groups?

We live in a changing world, a world in which human rights are under threat. We cannot accept this. We can no longer be passive bystanders to the normalization of inequality and injustice. When the world falters, those with the fewest resources, those already struggling to survive from day to day, are the first to stumble and fall. The most vulnerable are also the first to be sidelined and, in this case, left out of the care system and addiction treatment or harm reduction services.

Why are certain groups or individuals vulnerable?

The fault lies with a global system that tends to oppress or deprive certain groups of opportunities other groups are entitled to. The minority stress model provides some key elements to help us better understand the issue. The model posits that identity-related stress factors – e.g. being aware of one’s own marginalization due to one’s sexual orientation, race, functional diversity, etc. – have a negative consequences on the stress and discrimination experienced throughout life, which in turn has a direct impact on social and health outcomes.

As regards substance use, minorities’ experiences of discrimination are linked to higher rates of substance use disorders, as per the DSM-V criteria. Based on this model, belonging to a number of disadvantaged groups (e.g. gender, racial and sexual minorities), the consequences on people’s mental health could be even more dire as a result of the marginalization and stress associated with minority identities. This could be seen as an additional approach, in the sense that the addition of multiple stressors related to minority identities is likely to have negative consequences on health – not to mention the fact that all these discriminations and stigmatizations are constantly interacting.

Negative world view

The association between intolerance of uncertainty and addiction has been identitfied during the coronavirus pandemic – Image: Shutterstock

Impact on addiction treatment policies and programmes

While drug policies and treatment programmes provide an effective response to a part of the population, they are not adapted to our diverse reality. The androcentric, ableist and adultocentric vision – among other characteristics –  fails to take into account the wide variety of existing realities, resulting in so many obstacles to access and adherence to treatment and, consequently, a violation of people’s fundamental right to receive adequate care.

Intersectionality: an essential perspective

The concept of intersectionality describes how systems of inequality based on sex, race, ethnicity, sexual orientation, gender identity, disability, social class and others ‘intersect’ and generate unique dynamics and effects.

First coined by Professor Kimberlé Crenshaw in 1989, the concept entered the Oxford dictionary in 2015 and its importance has only grown, especially in the field of women’s rights.

Each individual simultaneously possesses different social identities. For people with oppressed identities, the concept of intersectionality helps to describe how the interaction of these identities produces overlapping systems of social oppression that manifest themselves in different areas of life.

Put simply, according to intersectionality theory, all oppressions are interconnected. As the Oxford dictionary puts it, it is the theory that various forms of discrimination centred on race, gender, class, disability, sexuality, and other forms of identity, do not work independently but interact to produce particularized forms of social oppression. As such, oppression is the result of intersecting forms of exclusionary practices.

The concept underlines the fact that everyone’s experience of discrimination, stigmatization and oppression is unique, and that we should therefore take into account all that can marginalize people.

Conference room

A view of the room hosting the addiction conference in Kutná Hora, Czech Republic – Photo: all rights reserved

Women, LGBTI+ population and children: much remains to be done

According to the United Nations, one in three people who use drugs is a woman, yet women account for only one in five people in treatment for substance use disorders. Women who use drugs face multiple vulnerabilities as well as structural, social and cultural barriers to accessing support services, as Dianova has repeatedly stressed it.

LGBTI+ people are also very vulnerable. Around the world, living your life as a homosexual or transgender person exposes you to many dangers, with discrimination and violence taking many forms – it should be remembered that some 64 countries still criminalize LGBTI+ people.

These barriers include a lack of security, a lack of understanding of the specific needs of LGBTI+ people, the stigma and discrimination they face (from society and clinical staff), and the absence of protocols for dealing with the physical or psychological violence they may suffer.

Finally, it is worth highlighting an issue that is gaining increasing recognition on the political and social agenda, even if there is still a long way to go: the perspective of children’s rights when it comes to addressing addiction-related problems. Children whose parents use drugs are at the intersection of two axes: children’s rights and drug policies. Each of these areas is the subject of numerous approaches, laws, regulations and political interventions that are constantly evolving and associated with human rights, even though they do not always translate into sound intervention practices.

Every child has the right to live in a functional family, and every parent has the right to be supported in bringing up their children so that they can fulfil their potential. The children and other family members of a person with problematic substance use are likely to suffer a range of social, economic and health-related harms.

The experience of these children has been described as a ‘hidden harm’, a term that refers to two of its key characteristics: the fact that children may suffer a number of harms associated with poor parenting; and that their experience is not recognized by, or even known to, relevant services.

When it comes to addressing addiction, professionals are often faced with two problems: on the one hand, they have to effectively protect children, and on the other, they have to support parents, while respecting their own pace and autonomy. This complex balance is the crux of the matter.

Rethinking programmes and services by eliminating barriers

Looking at reality from an intersectional perspective allows us to identify groups for whom services are often out of reach. It also allows us to identify the barriers and the means and actions to eliminate them. Putting this perspective into practice allows us to realize that these multiple and intersecting identities (women, LGBTI+, children, the elderly, etc.) have an impact on health and access to support services. Working to create more inclusive programmes contributes to social justice and answers fundamental questions in terms of ethics and the protection of people’s rights.

We would like to thank the organizers of the event, Magdaléna o.p.s. and the government of Central Bohemia for inviting us and for creating these essential spaces for debate.