The Social Problem Of The Street Level Addict

NAD Iceland September 2000
 

by

Esben Houborg Pedersen
PhD Student
Department of Psychology
University of Copenhagen
Njalsgade 88
DK-2300 Copenhagen S
Phone + 45 35 32 87 48
email ehp@sociology.ku.dk

Morten Nissen
PhD, Ass. professor
Department of Psychology
University of Copenhagen
Njalsgade 88
DK-2300 Copenhagen S
Phone + 45 35 32 87 50
email: morten.nissen@psy.ku.dk
http://www.psyk.ku.dk/mnissen
 
 
 

Introduction (Morten Nissen)

In the ensuing 15 minutes, we will present background, preliminary hypotheses, and investigation design of  a research project called The Life of Drug Addicts - between Cure, Care, and Control. This is a new research project that we are engaged in in co-operation with Center for Drug and Alcohol Research, Aarhus University, and financed by the Danish Government.
Let my first begin by presenting myself. I am working as assistant professor in Community Psychology at the Department of Psychology, University of Copenhagen. My general field of interest is pedagogical and social work practices, and I approach them from a primarily social psychological background. In particular, I have in the past 7 years been involved with community based development projects with socially excluded young (see also http://www.psyk.ku.dk/mnissen). That work on the theme of so-called street kids was an important background for the conception of this project.
Esben will begin with describing our project and its background in broad terms, including some of the general ideas which have informed our approach. I will then take over to elaborate on some of the problems and issues we are dealing with. We are in the process of articulating research problems and our intention with this presentation is to get some input to this as well as presenting the outline of our work.
 

Part I (Esben Houborg)

The overall project

The ambition of the overall research project The Life of Drug Addicts – between Cure, Care and Control is to view the totality of intervention on drug addiction in our society. This means that we will not investigate intervention from the view point of specific institutional practices, and that we will not restrict our perspective to certain forms of intervention and measures. Rather we will investigate the dispersion of different discourses and kinds of practices, which constitute what can be called the regime of practices (Dean 1999: Foucault 1991) through which we as a society deal with drug addiction. Included in this regime is discourses and practices of control as well as social work in its widest and most heterogeneous sense - including public institutions, private organizations, self-organized initiatives etc.
These discourses and practices will be analyzed in relation to the everyday life of drug addicts concerning how it influence and are influenced by this. (In a truly Foucauldian analytical strategy the everyday life of drug addicts would not be seen as something outside and separated from the regime of practices, but as an aspect of this).

In the first place we will conduct three different research projects dealing with discourses and practices which constitute different ways of dealing with drug use and drug addiction, that is: 1) Drug use and drug addiction as a part of everyday life, 2) drug use as an illegal activity, and 3) drug use and drug addiction as a social problem. Of course we will analyze how these different ways of dealing with drug use and drug addiction intersect and overlap, both in the course of the individual research projects and later in cooperation between the different projects.
Evy Frandzen and Lau Laursen will do the research into the control system. Karen-Ellen Spannow and Vibeke Asmussen will investigate the everyday life of drug addicts. And the practices of social intervention in all its heterogeneity is ours to investigate. The research will be done in three Danish cities.

Our part of the project

Within the framework of our part of the research project we will focus on social work done in and around the everyday environment of drug addicts, where we will seek to encircle the dynamics of discourses, social settings and actors of these practices and characterise im-portant developmental trends and contradictions.
To a large extent we will not be investigating treatment or cure of addiction, which takes the drug addict out of the everyday environment. The reason for this is. First, that the central concern of the research project is how interventions contribute to the structuring of the everyday lives of drug addicts, which  means that our investigations will be directed at the interface between the social system and the everyday life of drug addicts. One of the important aspects of our research, which Morten will have more to say about, is the changing character of this interface, and to some extent the blurring of the distinction between social system and the everyday environment of drug addicts. Second, that very few studies have been done of this social work – hence our investigations will have an explorative character. This, however, does not mean that we will not be interested in the role played by the treatment system, and hence be drawing on work done in that area.
Some of our questions concerning the investigation of the social work done in and around the everyday environment of drug addicts are:
Which actors are involved in social work with drug addicts? – different professionals, private organisations, user/self-organised, relatives etc. We will investigate positions taken by these actors and the dispersion and interaction of such actors and how they contribute to the production and reproduction of the regime of practices dealing with drug use and drug addiction. Included will be actors explicitly concerned with drug addicts and how the interpret the problems, wishes and needs of drug addicts and hence relevant measures; and other actors who are not explicitly concerned with drug addicts, but who deal with drug addicts on a regular basis, and the  “local drug policies” that are developed by these actors.
Which are the social settings of social work? We will investigate institutionalised social settings for dealing with drug addicts, especially those which constitute the thresholds of the treatment system, and those in which methadone-treatment is administered, but also other institutions which deal with socially excluded people. One of our main concerns will be the possible thresholds of such settings and the practices of separation and exclusion regulating admission. Is the system becoming increasingly differentiated in order to meet the different needs and wishes of different clients? What are the results concerning separation and exclusion of certain groups of drug addicts?
It seems that some public institutions are lowering their thresholds with reference to the objective of harm reduction. But at the same time other institutions seem to be making thresholds higher with reference to effectiveness in solving problems – moving away from care as an end in it self.
We will also be dealing with less institutionalised social settings, where we expect practices to be of a more negotiated/dialogical character. This concerns e.g. the street as environment for the interaction between social workers and drug addicts, and how social set-tings of social work are produced, reproduced and changed in such an environment. Also how social settings of social work are constituted as overlapping, intersecting or branched of from settings of police work – e.g. by establishing tolerance areas.
Other aspects of our research in relation to these different actors and social settings of social work are the methods and ideologies of social work used (e.g. the use and function of psycho-social, pedagogical, dialogical, case-management skills) and the power relations produced and reproduced (pastoral, disciplinary, empowerment and otherwise).
The role and function of harm reduction discourses and practices for the constitution and regulation of drug addiction as a social problem, will play an important part of our investi-gations.
Of special concern will be the social functions of harm reduction, i.e. practices of separation which organise social categories and identities, especially the constitution and function of categories such as “the most excluded”, “persons outside the reach of treatment”, “persons not motivated for treatment”, or “persons who will not benefit from treatment.” (The guidelines following the legislation the Social Department categorise drug addicts in three categories with respect to their condition and potential rehabilitation and list differentiated objectives for the measures directed at different groups).
Discourses and practices concerning long term methadone-treatment will of course be included, as it is a measures which structure the everyday lives of many drug addicts. Changes and regional differences in methadone-policy will be investigated, e.g. how a lowering the thresholds for methadone-treatment, alter the relations between professionals and clients. E.g. the view by some professionals that methadone now by some drug addicts is seen as something close to a social right.
An interesting question for us could also be: How harm reduction has come to be an important part of Danish drug policy to day, and hence the constitution and regulation of “the drug problem”?
We would  not view this as the outcome of a civilising process, where we finally have come to see drug addicts as citizens entitled to humane treatment. Neither will we just see it as a result the struggle between different ideologies and models of drug policy. We will investigate harm reduction in a historical perspective, in which we of course will be dealing with HIV as an important impetus for implementing measures of harm reduction, but also and mainly the question if changes in the functioning of the welfare-system constitute new forms of power relations between providers and clients/users which make harm reduction measures possible (and perhaps even necessary – from within contemporary discourses of social policy and social work?).
When we consider the development and function of harm reduction in Danish drug policy, we would have to take into account the continued emphasis of control, which is also a part of recent drug policy development, and the apparent paradox of this (Lauersen 2000).

Part II (Morten Nissen)

Part of our starting point are preliminary hypotheses that are derived from general research on the development of welfare state, health and social work practices, and from the above mentioned earlier empirical projects. The hypotheses, at this point, have to do with some of the fundamental assumptions guiding and organizing social work in this field.
Let me begin at the empirical meeting place of interventions and drug users which we have chosen as our common point of reference, the street level.
The spatial metaphore suggests that the social constructions of the institutionalized social work are shrugged off and a hard material reality is faced. Yet we might approach this very suggestion itself as a discursive move. This does not mean, of course, that street level work can be reduced to a discursive element. Entering, or at least facing, the material reality of ‘the street’, means a real change in how social work is situated, and the change in situation is likely to lead to unexpected consequences that we can trace and analyze. Thus, we try to think of the notion of the street level as what we might call a situated discursive formation.
The idea of street level intervention is one important concept for a totality of user (or victim) interface in the area of drug addiction intervention (one among others such as ‘public health’, ‘the meaning of services in people’s everyday life’, ‘critical paths’ or ‘care/treatment trajectories’). Studying social work organizations/systems and policies, the street level can be seen as the bottom level of the organization, and the ‘front-line’ in service delivery and policy (Lipsky, 1980). But what is also specific to a ‘street level’ focus, in this field, is the insistence that the agents of intervention directly encounter, if not actually leave home to enter into, a physical no-man’s land or territory that is inhabited or frequented by target groups.
The ‘territory’ of the street level is very different from the ‘frameworks’ or ‘locales’ of the institutions such as treatment facilities as settings of social work. The institutions compel clients to certain behaviors and rules, either by the force of the law, or by the voluntary character of the client’s presence, whereas on the street, the agents of intervention must continuously legitimize their interventions. The alignment of the political, professional, and scientific concepts on ‘target groups’ and on ‘social problems’ is no longer accomplished by the space of the institutions.
On the other hand, street level is also very different from some other important notions by which institutionally defined intervention is transcended these days – notably, those of society and community. Under the general epithet of The Active Society, the state seeks to engage communities, citizens, and users in partnership responsibility for social well-being – and integration. The active society is an endeavor to call forth these as subjects endowed with certain forms of self-reflection, autonomy and responsibility. In contrast, the territory of the streets is thought of as a second nature in which agents maneuvre individually and governed by widely differing sub-cultural values and interests.
To be sure, there are points of overlap, conflation, or tension. When the ‘user’ is construed at its most utilitarian, as a consumer on a market, in the neo-liberal jungle, subjectivity and nature seem combined. But  when ‘community’ is most hailed as (colonizable) life-world, counterposed to late modern system worlds, that too resembles a precious wildlife preserve. The accountable and responsible subjects of the active society seem to have their right in the middle phase between the original paradizic nature and the concrete city desert, populated by predators, that results from its erosion through colonization.
The nature metaphor suggests itself once one compares the idea of street level intervention with the large-scale city planning and prevention strategies of earlier. Street level interventions engage problems directly, but they also accept as fate the environment in which they spawn. The focus on street level, thus, nicely matches, and indeed in some ways form part of, the overall turn toward harm reduction in drug policy.
On the other hand, it also calls attention to a kind of reality which was never really handled in the traditional treatment system with its emphasis on removing the client from the assumingly harmful street-level subculture and pressure groups. The magnetic attraction of the street was then fought as an external threat, a force that would drag the client out of intervention and back into the streets. As the site of intervention, now, the street scene is nuanced and differentiated into both hostile and benevolent forces. And from this perspective (in the general non-/ framework of street-level reality), the re-/ establishing of coercive or hospitalized institutionalization can be problematized anew.
The street level totalities represented in our study are cities. That focus reduces the totality of social drug problem intervention since it leaves out certain problem features such as city-countryside traffic of drugs and addicts, or inter-state relations. Nevertheless, focusing on the city still establishes a tension to the categories of political, administrative, or professional domains. Street level drug problems demonstrate how, in spite of ideal intentions, even a quite local geographical totality remains inaccessible to policy agents. Conflicts between county and municipal administration is but one example.
In fact, any idea of a totality is inherently paradoxical: it marks a movement out of the specialized and narrow and into the whole which surrounds it; but it is itself inevitably condemned to specialty - it is but one constructed totality among others possible, and, as such, any totality changes with historical changes.
This is apparent also when one reviews the workings of the ideal of a comprehensive and unitary treatment, a total intervention tailored to the needs of unique individuals (or: the addict as a universe of one), which the professionals have praised for some years. It seems that rather than the technological utopia of a complete and well-orchestrated apparatus, it is now the incentive for a dialogical relation with users as subjects, a line of development which seems to lead out of psycho-dynamics and into either pedagogical or political/ideological, community based practices, or strictly delimited, 'pragmatic' medical or behavioral models (or even both at once, as in the NA / Minnesota model, cf Østergaard, 1998). This may reflect the general tendency towards a ‘flattening of psychological space’ which Rose (1999) has suggested. That is, rather than construing personality or the psyche as a deep space of interpretation, in an interplay of inner truth and outer appearance, as was characteristic of social work before, now, increasingly, a direct link is established between the biological level of intervention and subjecthood (cf. also Howe, 1996). The very idea of addiction can even be seen as by near a perfect charicature of that discursive formation, and the array of paradoxes surrounding the discourse of 'diseases of the will' (cf. Valverde, 1997, Østergaard, 1998) thus may shed some light on that general development.
The ways in which the comprehensive, dialogical relation of the helping system with users on a street level is realized contain strong tensions. On the one hand, there is still a strong impetus to cordinate and centralize which has fueled thoroughgoing reforms in the Danish treatment system, materialized in a number of projects and institutions specialized in generality, and motivated endless professional round-tables. On the other hand, professionals are no longer, as before, obliged to act as one unitary system, to an absolute peer loyalty and hierarchical obedience (at least within a single organization); structurally enabled by the shifts toward local quality management, and pursuing dialogues on a micro level with autonomous users on (or just off) the street, each institution or facility seems to create its own image of the totality of intervention to which the others 'ought to' contribute. The system seems to change from a compartmentalized, serial production line into a more organic network of projects that each act on the totality of the individual, like pieces of a hologram.
This calls forth ideological mechanisms as each project or local network tries to mobilize and align problem definitions, users, social workers, and various resources in doable constellations. This might be a direct ideological mobilization with an absolute reference to transcendental values of some kind; or, conversely, it might be a renewed emphasizing of pragmatics (the ideology of pragmatism, perhaps combined with a technology of identity politics).
It seems, thus, that a point of contradiction and development may be precisely the mediation of local /organizational ideology (seen from within) and its evaluation, utilization, and manipulation from the outside. The prevalent dichotomization of this relation matches the emergence of a market-like structure (where impartial officials buy the services of zealous project entrepreneurs), and it also corresponds with the general dichotomy of relativism/fundamentalism which, as Parker has pointed out (1998), is a general feature of current post-/modern ideology (see also Nissen, 1999, in press a & b, Hirst, 1993).
One way to approach empirically the ongoing changes in totalities of intervention and its fundamental problematics is to look closely into boundary practices (Wenger, 1998) and (more broadly) boundary practice fields – where the limits of drug addiction as specific social problem are continuously drawn, yet keep moving; and where, thus, the social problem is again and again reconstituted in concrete practice.
The field of intervention in young people’s drug problems has, right from the beginning of what we might call the ‘modern’ drug problem, in the 1960’s, been such a boundary field of intervention. In some phases, drug problems have been seen and handled politically and bureaucratically as intrinsically to do with youth. In others, youth intervention is precisely established by marking a distinction to ‘adult’ drug abuse and the institutions that specialize in drug treatment, or to adult crime and punishment. The field of youth intervention car-ries its own characteristic discourses of dialogical pedagogics, and, on the other hand, its own reasons for making exceptions from it. Youth tends to relate to the broader social and cultural context in certain ways distinct from those of drug abuse in itself. The boundary field of young people’s drug abuse is one field where ‘social problems’ and social work continuously arise and are defined anew. We investigate it by a rather close action research cooperation with municipal development efforts directly in and just outside the field defined as prevention and treatment of young people’s drug abuse in Copenhagen.
Another boundary field, in many ways similar, is that of drug abuse and mental health. The field of mental health, in general, is by near immersed in drugs of various kinds. On the other hand, drug abuse, originally, was itself a psychiatric disorder, and still may be, de-pending on where we look. Special boundary practices such as ‘double diagnosis patients’, or the recent establishment of special counselling facilities for users of ecstasy or hash, provide a view into the movements of the practical discourses on the relations between drugs and psychic disorders or problems. We relate to this field primarily by way of a cooperation with an ongoing masters thesis study of users of a day care facility for double diagnosis patients (conducted by Anne-Marie Sørensen).

Part III (Esben Houborg)

Some considerations concerning research design.
The objective of the research project is, as mentioned, to view the totality of interventions in our society concerning drug addiction. So the first question is how to construct this totality. We will do this by mapping how the social system, in the above mentioned wide sense, is structured concerning actors and settings, by collecting and analyzing documents and doing interviews with key-persons.
After this initial mapping of actors and settings of social work, an analysis of the material will be done in order to identify different discourses and practices which constitute the field, and how they are dispersed in relation to the different settings and actors.
This leads to further investigation into specific discourses and practices and how they intersect, overlap or are branched of from each other, by seeking out certain settings of social work and doing interviews with actors there (individual and group). We will also try to get access to settings in which different actors from different settings of social work (or police work) come together. Alternatively we will bring such actors together.
Finally observation of social work done in and around the everyday environment of drug addicts (especially outreach and low-threshold social work) will be done by following social workers over a period of time. This is done in order to investigate dynamics of discourses and practices of social work  done outside the traditional settings, and to investigate how  such settings of social work are established, reproduced and changed.

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