Sobriety is Not Superior

Social acceptance for people who use substances moves at a glacial pace.

People who use substances continue to face immense levels of stigma and discrimination. They are confronted with dehumanizing attitudes and barriers that limit their access to housing, healthcare, and other essential services. When this stigma and discrimination is paired with racism, anti-2SLGBTQIA+ bias, classism, and other forms of oppression, it becomes all the more difficult for people to access the services they need.

We have seen increased attention to the barriers faced by some folks who use substances in St. John’s through the activism of Tent City For Change residents outside Colonial Building. In late November, the City of St. John’s made a controversial decision to close public bathrooms in Bannerman Park, adjacent to the encampment, citing staff safety concerns from substance use in the area. 

The history of drug criminalization in Western countries is rooted in colonialism, racism, and class oppression. People who use substances come from many backgrounds; but those who do not belong to the  white, hetero-patriarchal, middle-or-upper class have largely been the ones positioned as dangerous and frightening.

There is a common assumption that people who engage in substance use can’t be trusted to make their own decisions. This positioning prevents substance use from becoming popular where it might threaten the authority of the status quo. As social learners, we are all products of our society, and we internalize ideas of “good” and “bad” as we see them play out  in our social systems. We have been taught that drugs, and the people who use them, are  dangerous, destructive, and something to be afraid of. We’ve also been told that those who use substances deserve any hardships they experience. 

While social bias against people who use substances is widespread, it is not leveled against everyone equally or in the same ways. Other forms of discrimination intersect with substance use stigma to push those of us with multiple marginalized identities further outside of our communities. People of marginalized genders—trans and cis women, Two-spirit people, nonbinary people, and transgender men—who also use substances, for example, face compounding forms of discrimination: both on the basis of their substance use and gender identity. 

Women who do not adhere to gendered expectations are ostracized in particular, as well as those who bend gender norms more broadly. Gendered double-standards mean that women’s substance use is more stigmatized than men’s. Women who use substances are often seen as deviant, unfeminine, and fundamentally “bad.” We are quick to turn away from women who use illicit substances, or who experience substance dependence of any kind. 

Women also face unequal outcomes when they seek support for substance use. Due to the expectations of women to be primary caregivers, they are more likely than men to face negative consequences, especially if they are parents. Further, substance use disorder assessments and treatment models are most often based on the experiences, needs, and safety of men. In reality, women may use substances differently, experience different symptoms, and often have distinct requirements for safety.

Ultimately, the needs and voices of women and gender-marginalized people who use substances have not been sufficiently heard by the substance use intervention sector, nor the activism of the feminist movement. Research by the Managed Alcohol Program at the St. John’s Status of Women Council (SJSWC) found that beyond its own local model, no other managed alcohol programs could be found that operate with a specific focus on women and gender-diverse people. Gendered harm reduction services are invaluable for community members to feel welcomed, safe, and comfortable enough to participate. 

We often think about forms of oppression, such as sexism, racism, or classism, as separate entities, having completely separate spheres of influence on our lives. Intersectionality, a framework developed by Black legal scholar Kimberlé Crenshaw, challenges us to examine how not everyone experiences oppression to the same degree, or in the same ways. Experiencing more than one form of oppression gives a unique shape to our lives as we navigate multiple compounding social barriers. Intersectional feminism calls for us to advocate for the needs of women at the intersections of oppression in the collective fight for equality and justice. Women experiencing compounded oppression often require additional resources and support to meet their needs. 

The resistance to recognizing people who use substances as valuable community members hinders our ability to reach collective liberation and justice for all. The systems which push people who use substances to the outskirts of society are the same systems which thrive on the oppression of women and gender minorities. While the effects of oppression manifest in different ways, these effects all originate from the same source. Ultimately, no one can achieve meaningful liberation while others are still oppressed. 

The marginalization and erasure of people who use substances is not an accident; it is the result of policy choices. Housing, healthcare, and economic crises have intersected to make it incredibly challenging for people to keep themselves safe and to meet their basic human needs. While not all residents of the Tent City for Change protest encampment in St. John’s use substances, we see how folks have been driven further into poverty because they use substances, and  housing and healthcare providers refuse to  accommodate them. When the municipal and provincial governments recently pointed fingers about who is responsible for responding to the barriers faced by Tent City residents, it is clear that systems are not prepared to address their own involvement in helping create the barriers in the first place.

So, what can we do about it? A meaningful approach requires us to recognize the many ways oppression affects people’s lives – all people, even those who live differently than us. Turning to the principles of harm reduction, we can see a way out of the unrelenting stigma against people who use substances. Harm reduction is an approach that works for many people who use substances. It is a framework that normalizes the fact that people use all kinds of substances, and it aims to uplift people who use substances as worthy of self-determination.

Stigma, discrimination, and the ongoing criminalization of substance use are, in fact, the key barriers that prevent folks from accessing healthcare and social supports and result in isolation and marginalization. People who use substances can identify what they need to be safe and supported. Harm reduction calls for us to increase safety for people who use substances where possible, to ensure that safety is person-centered, and to understand that people do not have to be sober in order to be fully deserving of community and government support.

Ultimately, it is a feminist imperative to rally behind people who use substances and amplify their demands for justice, care, and acceptance. A good place to start is critically examining our own attitudes toward substance use. Where do they come from? What have we been told about people who use substances? Who benefits from seeing marginalized people as disposable or as collateral damage?

Once we recognize that we have been taught to abandon and punish those who don’t fit, we can identify avenues for change and begin to see that a better world that fits us all is possible. 

Laura Tarrant
Managed Alcohol Program