Cultural Humility �for Working with People Who Use Drugs & People Experiencing Homelessness
Dass, Anami (2024)
Anami Dass
Director - Harm Reductionist Media (HRShare.org)
Board Vice President – NM Harm Reduction Collaborative (NMHRC)
Board Member – Advocates for Transgender Equality (A4TE)
Chairwoman - Albuquerque Human Rights Board (HRB)
….& Person Who Uses Drugs
(she/her)
Presentation By:
People Who Use Drugs�(“PWUD”)
Carl Segan
astronomer
(cannabis)
Marion Berry
DC mayor
(cocaine)
Kristen Bell
actress
(psychedelics)
Carl Hart
neuroscientist
(heroin)
…and countless others
Stigma�(PWUD)
Overt�
“Drugs & Drug Dealers are evil.”�
“PWUD are…
“I was a (slur for PWUD), but I got clean.”
Covert�
“Drugs are bad for society”�
“It would be ideal if people were sober.”
“PWUD can get better.”
“I used to use drugs, but I’ve been clean for years.”
“Abstinence is the only form of recovery.”
“Death of Despair” �(implying overdose is related to suicide)
“We need to hold users accountable.”
Overt Stigma�(PWUD)
“Drugs & Drug Dealers are evil.”
Drug dealers are community leaders who take on the risks associated with acquiring a resource. �
“PWUD are Criminals/Dangerous/Liars/Stupid/Gross/Lazy/Incompetent/Out of Control/Selfish/etc.”
A lot of people use drugs.
“I was a (slur for PWUD), but I got clean.”
PWUD aren’t dirty.
Self-Identifying as a person who used to use drugs problematically doesn’t negate the harm of using pejorative terms for others.
Covert Stigma�(PWUD)
“Drugs are bad for society”�Drugs are a product of societies, and humans have always used drugs.�
“It would be ideal if people were sober.” �Abstinence isn’t for everybody.�
“PWUD can get better.” �Drug use is not a sign that something is “wrong”.
“I used to use drugs, but I’ve been clean for years.” �PWUD are not dirty. Abstinence isn’t purity.
“Abstinence is the only form of recovery.” �Recovery includes alternatives to abstinence”
“Death of Despair” �Accidental overdose is not suicide. Drug use can be celebratory, ceremonial, and experimental.
Consistent Boundaries�(PWUD)
Prejudicial Boundaries
Setting differing standards for people who use drugs than for others.
Results in:
Healthy Boundaries
Maintaining the same rules/expectations for everyone regardless of drug use.
Results in:
Stigma against�(People Experiencing Homelessness)
Overt�
“ They’re all on drugs.”
“The homeless are…
“I was homeless once, but I made the choice to seek help.”
Covert�
“Homeless individuals need treatment.”�
“Homelessness brings crime.”
“Some people just don’t want help.”
“When I was homeless, I didn’t act all crazy. I worked hard to rebuild my life.”
“Back in my day it didn’t used to be this bad.”
“Beautification” “Public Safety” etc.
“We need to hold the homeless accountable.”
Consistent Boundaries�(People experiencing homelessness)
Prejudicial Boundaries
Setting differing standards for people who are unhoused than for others.
Results in:
Healthy Boundaries
Maintaining the same rules/expectations for everyone regardless of housing status.
Results in:
What Stigma Does to PWUD &�People Experiencing Homelessness?
Practical
Barriers to Treatment/Support
Mistrust of Medical Providers
Over correcting and attempting abstinence before they’re ready
People pleasing behaviors
Increased chance of suicide, overdose, overuse, and relapse
Personal
Disengaging with treatment/Support
Internalized Stigma
Feeling a sense of obligation and followed by feelings of failure
Negative self-perception and self-talk.
Loss of connection with provider, and sense of hopelessness
Gears of Influence
Gears of Influence
Gears of Influence
Gears of Influence
Gears of Influence
Gears of Influence
Gears of Influence
Gears of Influence
Gears of Influence
Gear Grinding
Clients
Both
Front Line Workers
Gear Grinding
Management
Both
Front Line Workers
Repair Methods
Internal
External
Check-In
Smart Tool 2.0
Safety
Measure
Adjustments
Re-Evaluate
Tracking
A tool for empowering clients to reduce harm.
Smart Tool 2.0
Safety
Clients choose what concerns are most prominent to them. Providers can suggest concerns but this process needs to come from the clients.
What potential harm comes from this behavior?
What issues have I been experiencing relating to this behavior?
What worries me (or others) about my behavior?
Smart Tool 2.0
Measure
Clients walk the provider through their current process.
When? Where? How much? With whom? Etc.
Example: Injection Substance Use
What tools do you use? Do you use new cookers and filters each time? How long do you cook before loading a syringe? Do you have surplus new syringes so you don’t have to reuse? Once you tie off, how long do you take before injecting? Where are you when you’re injecting? Are you safe to take your time or are you having to hurry?
Smart Tool 2.0
Assessment
Find potential incremental adjustments that can be implemented to increase safety at each step of the behavior(s) process
When? Where? How much? With whom? Etc.
Example: Lashing Out violently when triggered by annoying sounds.
Smart Tool 2.0
Re-Evaluate
Looking at these alterations in behavior, this step assesses if the risks from the “safety concerns” are eliminated or lessened as a result.
This step also can function as a reality check as to what alterations are achievable and what alterations are overly optimistic and leave gaps in safety.
Smart Tool 2.0
Tracking
This is the last step, but leaves the plan ongoing, thus allowing for changes in the client’s plan as their behavior shifts.
Monitor how these efforts go over time.
This also allows the client to see progress and locate challenge areas in the form of data, which can assist with building a evidence-based perspective on their behavior (for both provider and client).
Questions?
Download the �SMART 2.0 toolkit at �www.HRShare.org/SMART
Smart Tool 2.0
Safety
Measure
Adjustments
Re-Evaluate
Tracking
Original Presentation by Anami Dass, Director of Harm Reductionist Media/HRShare © All Rights Reserved. �Dual Diagnosis Training Summit, Homeless Coordinating Council for the City of Albuquerque, Bernalillo County, and the University of New Mexico.
September 11, 2024. More information at HRShare.org and AnamiDass.org