Centre for Hidden and Marginalised Population Studies
OUR PARTNERS
At CHAMPS, we work with organisations and partners that work to help reduce the harms associated with drug use and the climate of moral and legal censure due to drug prohibition.
Hidden population research
There are numerous early accounts of reports of drug taking that occur throughout history. From these very early ethnographic reports of drug use, a lesson can be learned. Ethnography takes place in a cultural context, affecting both the observer and the observed. Drug ethnography, in particular, is a matter of one group with a certain viewpoint studying another group with quite a different viewpoint.
So how and in what way have hidden populations been described, researched and categorised? Who are typical or traditional hidden populations? In short they are groups that are hidden from traditional mainstream data collection, whether by academic, government or state agencies, and are difficult to create representative samples from.
They are hidden because they may be homeless, or wish to remain outside the gaze of state surveillance mechanisms such as medicine, particularly psychiatry, social work, education, housing, and the police.
They may also be hidden because they are highly stigmatised groups who use drugs, engage in sex work, or other criminal acts, and may also be in receipt of illegal benefits, and they are hidden because to be discovered would subject them to penalty or have suffered shame, stigma and discrimination. In this sense they act to remain hidden purposively. However there are certain groups that are easier to find than others. These who form part of visible, but may also attempt to remain hidden, albeit less successfully, than other hidden populations. Those hidden populations who remain hidden I will refer to as ‘the intentionally unseen’ who wish to remain out of the gaze of others who may label them, shame them, stigmatise and discriminate against them.
The intentionally unseen operate as active subjects, resist their perceived and actual oppression by engaging in acts and behaviours that are considered beyond what is considered acceptable.
Marginalised populations research
In recent decades, alcohol and drug treatment services in the UK have undergone processes of transformation at the organisational level. Alongside increasing professionalisation of drug workers, the concept of recovery has gained popularity as a measurable outcome of behaviour change from the problematic misuse of alcohol and other drugs (The Scottish Government, 2008). Thus, while the problem drug user has been historically constructed as shameful, problematic alcohol and other drug users now have access to a particular type of status. Discursively, the focus on recovery from drug and alcohol misuse as definition of successful behaviour change, and the construction of the non-user of illegal drugs as normal creates tension between drug workers, service providers, and policy makers and ex users in recovery engaged in service user involvement.
Most definitions of recovery refer to a state of sobriety and being drug free (Betty Ford Institute Consensus Panel, 2007). However, recovery is not clear to the public, to those who research and evaluate addiction interventions, and to those who make policies about addiction. Indeed, there is reason to believe that there is no complete consensus on the definition even among those in recovery (see Laudet, 2007; Laudet, Morgen, & White, 2006).
The term ‘recovery’ is increasingly associated with overcoming the problematic misuse of alcohol and other drugs. In this context, recovery is generally thought of as becoming abstinent from substances that one consumes problematically. Recovery is considered to be an event, i.e. becoming abstinent; however it is also considered an ongoing process, whereby the end goal may be achieving control over use of formally problematic substance misuse, or becoming free from dependence. It is the latter definition of recovery that infers controlled use is a possibility after problems become evident, something considered impossible if addiction is understood to be a disease (Sobell and Sobell, 1971, 1992, 2001; White 2001).
User involvement: the gaps between policy and practice
The term ‘service user’ refers to a person who is a past or present user of drug or alcohol treatment and recovery services. Service user involvement (SUI) refers to the policy objectives of having the voices of service users heard and included in policy and service delivery.
The ethos behind service user involvement stems from the recognition that inclusion of patient groups in the planning and provision of services can have a positive effect on treatment outcomes. Service user involvement emerged from the concept of Citizen Advocacy originally discussed by Sherry Arnstein in 1969, describing a ‘ladder of participation’ which sets out eight progressive levels ranging from non-participation to citizen power. It has developed to provide understandings of how SUI can develop, from simple information-giving and seeking service users’ views on proposed developments, through to services where service users generate ideas for action and make all the major decisions.