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European Coalition for Just and Effective Drug Policies
International Drug Policy Consortium
Social Inclusion & Health
The concept of acceptance and what it means for our work
orientated drug policy", "low threshold drug
services" and "accompanying addiction":
- these have become common catchwords, and it would be
hard to find a drug work concept that doesn´t use
these slogans, demonstrating that this kind of "service"
is in great demand in the social service sector.
is a market now being served both by the larger, formerly
abstinence orientated organisations, and also increasingly
by the smaller self-help initiatives, all peddling their
versions of low threshold support and acceptance. The
phrase "acceptance orientated drug work" was
originally coined to distinguish this method and its
underlying concept from the mainstream of drug social
work, whose practical and theoretical efforts were directed
almost exclusively towards total abstinence.
is now a key word in several areas of social work, but
what exactly does it mean? For example, does it mean unconditional
acquiescence in dealing with violent, right-wing teenage
gangs? Or, in the field of drug work, indifference and
minimising the dangers of addiction? First and foremost,
acceptance means offering a dialogue between different
values and ways of living, instead of adopting a policy
of exclusion. This is the only foundation on which it
is possible to build reciprocal understanding of conflicting
lifestyles, and how they originated. For people who take
illegal drugs, or who have to take them, for example,
illegality is the dominating social factor in their everyday
lives: living with the black market, exposure to differing,
and sometimes deadly contaminants in unpredictable levels,
all this leads to the health risks which we set out to
alleviate, via the suggestions offered in this brochure.
controls are on the increase: since the mid 80´s
The Federal Criminal Office can point to a growing number
of offences involving drug users and dealers. In 1994,
187 000 drugs related crimes were registered - three
times as many as in 1984. A considerable amount of those
brushes with the police involve possession and consumption
of cannabis (43%) but there has been a marked increase
in offences connected with LSD and amphetamines, while
heroin and cocaine related offences have stayed more
or less constant. In addition, the police now register
so called "first hard drugs offenders", a
statistic showing drug consumers who have come into
conflict with the law on counts of hard drugs usage
(opiates, cocaine and synthetic drugs) for the first
time. Between 1986 and 1996 these numbers rose to 17
000 - four times as high.
offences are "control offences", that is,
they mirror the level of law enforcement controls and
don´t necessarily represent the real development
in drug use. As few people report each other in this
sector, the police have to rely on intensive investigation,
and on informers. The increase in statistics indicates
the growing intensity with which the law tries to control
drug users, and means that sooner or later all users
run a relatively high risk of coming into contact with
the law, either through buying, possession or dealing.
prosecution, non-voluntary therapy, police interrogation
- this all leads to social ostracism, followed often
enough by broken contacts to friends, family, lovers
and partners, thus swelling the ranks of the dispossessed
and hopeless people living on the edge of society. This
policy of stigmatisation cultivates a climate of non-solidarity,
where drug users become the law´s spies and informers,
effectively preventing them from finding common political
ground; a collective stance, voice and action. It splits
people up, and leads to an atmosphere of fear, mistrust
and brutalisation. As the Bremen prisoners´ paper
DISKUS put it, in their obituary for two people (both
drug users), who committed suicide while in prison:
"When the dealer heard about Wolfgang´s death,
the only thing he said was `Shit. He owed me DM 20,--´"
It is almost impossible to convey what living outside
the law means to someone who hasn´t experienced
statistics in the daily papers about the high rate of
'HIV infection, the spread of viral hepatitis infections,
sexually transmitted diseases, tuberculosis, bacterial
eco-carditis, kidney diseases and the high death toll
among drug users can only give a very limited impression
of what it is like to be existentially threatened in
Workers in the field of drugs acceptance who are confronted
daily with these diverging life patterns have learned
to look more closely, to differentiate and question
the media-created image of the bad guy fixer. Do drugs
create this picture of misery, - or is it the result
of a faulty drugs policy, of a vicious circle revolving
around criminalisation and prosecution?
We notice in our daily work, that the problems caused
by drugs policy are so overwhelming, that they outweigh
by far any problems caused by the addiction itself.
Hardly a moment goes by in drug work, which isn´t
marked by the effort to cope with the consequences of
illegality and prosecution (debt, wage forfeit, deterioration
in health, the fight to avoid imprisonment or to be
Differentiated Understanding of Addiction
also means not regarding users of illegal - or legal -
drugs as a priori being in need of counselling, treatment,
or in any way as "objects of therapeutic desire",
nor does it view them in the light of society´s
need to punish or banish them. This school of thought
(a mixture of criminal law and counselling/therapy) is
still alive and well and claims that the "end"
(abstinence) justifies any "means" available,
for example the baby phase theory, in which the sinner
has to start again from scratch, or confrontation sessions
in long term in-patient therapy, in which participants
are supposed to yell violently at the patient until he
reaches the "rock bottom" and can be helped
to rebuild his life afresh with a new orientation, new
friends, new clothes etc. - A dark chapter in recent therapeutic
and psychiatric history.
Acceptance drug work differentiates between regarding
drug consumption as a conscious consumer decision either
for pleasure, self medication, or as a lifestyle; or rather
as an illness - needing adequate forms of aid or therapy.
The self definition of the individual takes precedence
in our form of drug work, and not the cosy "We know
what´s best for you" attitude, with its patronizing
style of caring.
This means that we support self help, providing room (-
and rooms -)for self help initiatives to promote consumer
safeguard measures (for example safe use of party drugs),
find ways of political articulation or exchange practical
help. For us, it is important to support the forces of
self healing and enable competence in the people affected,.
In this way we hope that drug users will create their
own political platform to voice their needs, and go from
powerlessness to autonomy.
This does not mean that professional help is superfluous;
it becomes necessary whenever a greater degree of knowledge
or ability is called for, or when a more neutral kind
of aid is needed than can be provided in a self help setting.
Acceptance also means speaking out about the dominant
drug policy of repression, with its current practice of
dismantling the drug scene and drug based prostitution,
with no regard to the health and social risks involved.
The law and order policies favoured by local government,
and their treatment of the "open drugs scene"
completely ignore the fact that drug users, especially
those further down the scale of neglect, need some kind
of space to communicate and exchange help. Forcibly dispersing
visible groups of drug consumers is nothing but social
cosmetics, and probably won´t even help raise the
level of perceived security among the general public;
the consequences are already all too visible in our cities.
Acceptance drug work takes the health requirements of
drug consumers seriously. Under conditions of partial
prohibition this means helping to minimise the risks entailed
in black market drugs, and living in illegality, such
as safer consumption through needle exchange and dispensing,
injection rooms, living space and job offers with no conditions
of abstinence imposed. First and foremost we need to prevent
irreparable harm such as HIV infection. In this connection,
consumer safeguarding means taking all possible steps
to avoid additional harm caused by criminalisation.
This is especially important within the prison system,
where between 10,000 and 20,000 drug using inmates are
obliged to cope without hygiene. For more than 10 years
now, the word on the streets has been "harm reduction"
and "safer use", but once inside they can forget
they heard it..
Problem Areas of Acceptance Drug work
"Only help helps!" - Is that all that helps?
"Only help helps!" was the heading on a Frankfurt
AIDS-Help Association pamphlet. But is it true? Shouldn´t
the dialogue method of acceptance drug work described
above be extended to include residents, school children,
the Police, legal institutions and politics? To defuse
clashes with local government we need acceptance drug
work representatives at the round table, - together with
user participation, - to argue for more humane drug policies.
That public order policies and health policies don´t
have to occupy opposing corners has been demonstrated
by concepts developed by local branches of "Akzept".
In Bremen the "Utrecht Modell" for better conditions
for people working in drug based prostitution was discussed.
Health rooms and advice shops would also fit both agendas.
It can´t be stressed often enough that there is
no single easy course of action, either for drugs policy
or drugs aid, and that it is far more important to expose
and do away with the negative symbols beloved of traditional
drugs policy, such as "demon drug", "foreign
drug pushers" etc.
and Opportunities of Professionalisation
drug work started as a political movement with a practical
approach, effectively exposing the gaps in the old one-dimensional
(abstinence orientated) drugs aid system. Nowadays,
acceptance drug work is recognized as an effective part
of work with addicts, and receives substantial subsidies
(considering the process only took 10 years) under the
heading of "harm reduction". But this development
also entailed significant change and compromise: Sponsors
expect a consistent, on the spot social service, which
they will pay for, - with no ideological extras or political
involvement. The image acceptance drug workers have
of themselves nowadays is therefore of professional
problem managers for certain peripheral social groups;
that is, their involvement with their clients these
days is no longer simply a matter of course, but has
become a matter of method: dialogue is only possible
when you get close to people. An increasing tendency
towards professionalism, and to a certain extent bureaucracy,
has set in, not unlike the process in the "release"
movement in the early 70´s.
Apart from its uses, this process also runs the risk
of giving way to its own momentum and for professional
and economic reasons helping to create a pathology for
its clientele. An early sign of this seems to be the
"discovery" of the double diagnosis: psychiatric
disorders couched in psychiatric terminology are employed
in order to demand more auxiliary aids and special wards:
"Jump like a tiger. - Land like a rug??"
the integration of practical acceptance drug work into
existing care taking structures, and especially in view
of the economic dependence this entails, the room for
political and practical action (which often existed
in a "grey area" anyway) has narrowed considerably.
Dwindling municipal budgets are making life difficult
for many small organisations and their workers: sponsors
expect a simple social service inside a certain scope,
and aren´t interested in political action, resolutions,
and symbolic demonstrations against hostile narcotics
legislation, which in any case seem to run contrary
to economic interests. Signs of "calming down"
are becoming visible among many formerly active organizations
in the field of drug work in the Akzept Association.
Of course they all have enough to do, running their
organizations and applying for next year´s financing,
but that also means less time to spend with people involved
with drugs, and to work with them towards creating better
drugs policy. We are in danger of falling into a rut,
and would do well to keep working on viable drug policy
alternatives, to keep pushing back legal boundaries,
and to exposing the traditionally prohibitive system
as obsolete - and expendable.
more acceptance orientated drug work becomes a consumer
product, the more we need to react professionally to
this challenge and consider it in its subject context.
There has been a great demand for our first publications:
"Leitlinien für die psycho-soziale Begleitung
im Rahmen einer Substitutionsbehandlung" (Guidelines
for Psychosocial Support during Drug Substitution Treatment)
(1995), and "Leitlinien der akzeptierenden Drogenarbeit"
(Guidelines for Acceptance Orientated Drug Work) (1999).
We intend to follow up this work, and broaden the scientific
foundations in this field.
What can be done?
combat the social ostracism of such a large number of
drug users, we need to draw up a drugs policy aimed at
integration, which can be implemented step by step on
a local and national level.
At a local level, this would mean re-integrating drug
addicts into the normal social services, from which they
have gradually been excluded and referred to "special"
services for addicts only: with special hours for methadone
maintenance (outside normal surgery hours); a special
service for needle dispensing; and special clinics (because
chemists and doctors refuse to treat addicts adequately,
or sometimes at all). All of this creates a "special"
reality for drug users, intensifying their social exclusion.
But doesn´t acceptance orientated drug work reinforce
the existence of just such a "special" reality?
Couldn´t some of the specialized low threshold service
structures be taken over, and maybe even organized better,
along normal public service lines? Needle dispensing,
for example, should logically be a service offered not
only in contact cafés, but in normal chemists´
dispensaries, - which have longer opening hours, and are
already geared to cope with needle disposal. In some cases,
we also tend to integrate services which originally belonged
within the normal scope of public service systems into
the drugs aid system: debtors´ aid, employment and
residential projects organized solely around drug users.
Whereas integration means the opposite: it means ceasing
to treat drug users as "clientele".
Drugs aid sponsors and self help organizations need to
put an end to the "drug myth" with its prejudiced
language, fuzzy concepts and unrealistic ideas on the
origins, course and possible conclusion of opiate consumption.
In the community, practical information is necessary,
to establish effective local aid among, and with the help
On a national level, Acceptance work endeavours to rid
the penal code of a distinct "Narcotics Law",
and to regulate substances under the controls already
afforded by the existing laws (pertaining to medicines,
food stuffs, consumer goods etc).Criminal Law as an instrument
to influence people´s behaviour has not only proved
itself a failure, but has caused more damage than it has
done good. The double standard of a partial prohibition
only serves to make State drugs policy seem an arbitrary
matter. Treating two identical things so differently can
only be termed a policy of hypocrisy.
This unperturbed view of prohibition as being "normal"
has long ceased to be anything but absurd.
is the background against which Akzept e.V. stands for
normal attitudes towards dealing with drugs, and the
requirements of drug consumers in society.