11 minute read
The substance of social work
Notes on the conspicuous underrepresentation of harm reduction & substance use education in Canadian social work curricula
Dr. Christopher B.R. Smith
Substance use, harm reduction, and the meaningful engagement of people who use drugs represent a conspicuous absence in Canadian social work curriculum. I argue that a praxis-based toolkit is necessary to support social workers to openly embrace - and directly integrate - harm reduction in all aspects of policy, pedagogy, and professional practice.
PROPOSITION #1:
Regardless of the specific sub-field social work practitioners may choose to pursue – from gerontology, to child welfare, to housing – the use of psychoactive substances is a crucially important, central issue in literally all areas of professional social work practice. Be it in the form of older adults mixing up medications, child removal due to parental drug use, or individuals being evicted from social housing due to relapse, substance use is one of the single most critical issues common to every imaginable area of social work policy and practice. As I often inform students from the outset of my course on substance use: “You needn’t go looking for it –regardless of what path you pursue, within your first week of professional social work practice, issues relating to substance use will find you.” Here, student course evaluations have repeatedly called for making this elective BSW course a degree requirement.
PROPOSITION #2:
Seeking to identify patterns and trends in Canadian social work training and research, Rothwell et al. (2015) conducted content analysis of social work dissertations. Utilizing preestablished topic categories, Rothwell et al. (2015) reviewed 248 social work dissertations published between 2001 and 2011, determining that substance use comprised less than 1% of all dissertations published during this period. Situating substance use as a ‘key practice area,’ Rothwell et al. (2015) noted that Canadian schools of social work have “produced few scholars who can teach […] or produce research” regarding substance use (p.60).
More recent research clearly illustrates the highly marginalized status of substance use education in Canada. In their investigation of ‘the substance of social work’, Smith, Andrews, and Tobin (2019) revealed that an alarming 13% of English-language schools of social work across Canada lacked any content on substance use. Among the 87% of institutions that did, however, the vast majority (96%) were ‘elective’, while less than 5% of course(s) were ‘required’ (Smith, Andrews, & Tobin, 2019). In the absence of strong personal interest, most BSW students in Canada are, therefore, graduating with little, if any, knowledge of harm reduction, or other fundamentally important tools for working with PUD. In other words, the overwhelming majority of BSW grads are thus woefully unprepared to meaningfully engage with people who use drugs (PUD) – a fact that is particularly alarming in light of the devastating impact of covid-19 on skyrocketing overdose rates from coast to coast.
PROPOSITION #3:
Community-based and user-driven forms of harm reduction represent a form of living praxis, “creating fluid, in/formal spaces where practice can adapt to accommodate changing community needs” (Smith, 2012, pp. 215-216). Here, the lack of a commonly accepted definition is a strength, although the amorphous nature of harm reduction is precisely why social work authorities are wary of its integration as a core ethical principle. Harm reduction has thus come to represent a threat to regulatory bodies, which have a vested interest in policing social work’s fundamentally interdisciplinary – and inherently porous – disciplinary boundaries.
Offering what is perhaps the most comprehensive and progressive definition, Harm Reduction International (HRI) acknowledges the contested nature of harm reduction (2022). Similarly “grounded in [social] justice and human rights,” and focused on “working with people without judgement, coercion, [or] discrimination,” the terms ‘harm reduction’ and ‘social work’ are seamlessly interchangeable in HRI’s definition (2022, para. 2). In spite of its obvious complementarity with social work ethics, however, harm reduction remains neglected by social work educators and regulatory institutions. Articulating its commonly accepted principles, HRI (2022) goes on to details other facets of harm reduction that are seemingly incommensurable with social work, including (1) the “meaningful involvement of people who use drugs in designing, implementing and evaluating programmes and policies” and, (2) the goal of providing “alternatives to approaches that seek to prevent or end drug use” (para. 11). Given their implicitly moralizing –and increasingly deafening – silence on this issue, provincial and national social work regulatory bodies should therefore be strongly encouraged (read: required) to adopt standards of practice that ensure harm reduction is embraced as a normalized, central aspect of BSW education at schools of social work across Canada.
PROPOSITION #4:
Drawing from the growing body of literature on the intersections between social work and harm reduction, politicized practitioners must begin by calling for the widespread incorporation of harm reduction into all aspects of social work policy, pedagogy , philosophy, and practice, irrespective of any perceived challenges or points of disconnect. Equally important, however, is the task of establishing what can be referred to as a metaphorical form of safe supply in social work curriculum– a permanent, stable, standardized place for substance use education that is explicitly rooted in harm reduction praxis(footnote 1).
As illustrated by federal and provincial regulatory bodies, who, in turn, govern the conduct of individual social workers across the country, the substance of social work in Canada today is unquestionably fragmented, marginalized, and apolitical. I remain steadfast in my conviction, however, that with sustained, concerted, collective effort, the ideologically toxic state of substance use education in Canadian social work can be overcome through a reorientation of policy, pedagogy and practice that entails two distinct approaches. First, we must all acknowledge the close, complementary, symbiotic relationship between the philosophy of harm reduction and the ethical imperatives of social work in Canada (Vakharia, 2014; Vakharia & Little, 2016). Second, it is crucial to both re-establish a permanent, central, required place for substance use education in Canadian social work curriculum, and, moreover, call for the explicit adoption of harm reduction – in all of its complexity, fluidity, and multiplicity – as a core ethical principle of Canadian social work. Ethically, however, these objectives must take place in a relationship of collaborative autonomy with PUD (Cheng & Smith, 2009), involving a fundamental shift in the role of – and relationship(s) to – drug/service users (Smith, 2012). As they undeniably denote a “passive, one-way relationship to capitalist forces of production/consumption” (Smith, 2012, p. 211). here, we might begin by abolishing terms such as client and consumer from social work discourse.
Just as the U.S. Drug Policy Alliance produced Safety First, a harm reduction-based drug education curriculum intended to displace the ubiquitous D.A.R.E. program (Rosenbaum, 2019), in other words, social workers need a substance use toolkit that involves more than uncritically echoing ‘ just say no ’ and/or making repeated referrals to abysmally ineffective 12-step programs (Flanagan, 2014; Martin, 2011). As these objectives will invariably represent a threat to the very foundations of social work as a (paternalistic?) ‘helping profession,’ we must assume that our reorientation efforts will not be initiated in a top-down fashion by the regulatory institutions that govern practice.
If 30,000 opioid-related deaths over a five-year period hasn’t catalyzed change on the part of these authorities, in other words, what will? Instead, like most historical struggles for social justice, such changes must begin from the bottom up – by Canadian social workers coming together in solidarity to demand change. Following the example of nursing, where politically committed individuals established the national Harm Reduction Nursing Association ( hrna-aiirm.ca ). If only as a forum through which to continue this discussion, I thus conclude with an open call for educators, practitioners, students, and service users to assist in forming a Canadian Social Work Harm Reduction Collective. As I sometimes playfully, cryptically remind my BSW students: your future is political . During a period in human history when the stakes of passivity and apathy are, quite literally, life and death , be it in the dimensions of policy, pedagogy, or practice, the only remaining question is, therefore, what role will you play?
Footnote
1. One recent example of how regulatory bodies such as the Canadian Association of Social Work Educators (CASWE) have started to explore the relevance and application of harm reduction can be seen in the Opioid Use and Opioid Use Disorder Project. Undertaken in collaboration with both the Canadian Association of Schools of Nursing (CASN) and the Association of Faculties of Pharmacy of Canada (AFPC), this project was conducted by a committee consisting of both educators invested in substance use and a group of PUD, who consulted with countless stakeholder groups from across Canada to compose both Interprofessional Education Guidelines on Opioid Use and Opioid Use Disorder, along with a series of web-based training modules “developed for students and faculty […] who wish to learn independently”. To access the guidelines and/or web-based modules, see: https://caswe-acfts.ca/opioid-use-and-opioid-use-disorder-project. Although I was directly involved in all aspects of this work, in order to create meaningful, lasting change, I strongly believe that such initiatives must be transformed into required, everyday elements of social work curriculum.
References
Canadian Association of Social Work Educators (CASWE), Canadian Association of Schools of Nursing (CASN), and Association of Faculties of Pharmacy of Canada (AFPC). (2020). Interprofessional Education Guidelines on Opioid Use and Opioid Use Disorder. Retrieved from https://caswe-acfts. ca/opioid-use-and-opioid-use-disorder-project/
Cheng, R., & Smith, C. (2009). Engaging people with lived experience for better health outcomes: Collaboration with mental health and addiction service users in research, policy, and treatment. Toronto, ON: Ontario Ministry of Health and Long-Term Care. Retrieved from http://opdi.org/index.php/ knowledgeexchange/opdi_reports/
Flanagin, J. (2014, March). The Surprising Failure of 12 Steps: How a pseudoscientific, religious organization birthed the most trusted method of addiction treatment. The Atlantic Monthly https://www.theatlantic.com/health/ archive/2014/03/the-surprising-failures-of-12-steps/284616/
Graves, G., Csiernik, R., Foy, J., & Cesar, J. (2009). An Examination of Canadian Social Work Program Curriculum and The Addiction Core Competencies, Journal of Social Work Practice in the Addictions, 9(4), 400-413. DOI: 10.1080/15332560903212595
Martin, C. (2011, January). The Drunk’s Club: AA, The Cult That Cures. Harper’s, 29-38.
Public Health Agency of Canada. (2022). Apparent Opioid and Stimulant Toxicity Deaths: Surveillance of Opioidand Stimulant-Related Harms in Canada, January 2016 to December 2021 https://health-infobase.canada.ca/ substance-related-harms/opioids-stimulants/
Rosenbaum, M. (2019). Safety First: A Reality-Based Approach to Teens and Drugs. New York: Drug Policy Alliance. https:// drugpolicy.org/resource/safety-first-reality-based-approachteens-and-drugs
Rothwell, D.W. Lach, L., Blumenthal, A., & Akesson, B. (2015). Patterns and Trends of Canadian Social Work Doctoral Dissertations. Journal of Teaching in Social Work, 35(1-2), 46–64. https://doi.org/10.1080/08841233.2014.977988
Smith, C.B.R. (2012). Harm reduction as anarchist practice: A users’ guide to capitalism and addiction in North America. Critical Public Health, 11(2), 209-221. http://dx.doi.org/10.108 0/09581596.2011.611487
Smith, C.B.R., Andrews, S. & Tobin, C. (2019). The Substance of Social Work: (Re-)Mapping the ‘Place’ of Substance Use Education in Canadian Social Work Curriculum. Primary Healthcare Partnership Forum (PriFor) 2019: Learning Health Systems. Memorial University, Signal Hill Campus, St. John’s, NL, 27-28 June 2019. (Poster Presentation).
Vakharia, S. P. (2014). Incorporating substance use content into social work curricula: Opioid overdose as a micro, mezzo, and macro problem. Social Work Education, 33(5), 692–698. https://doi.org/10.1080/02615479.2014.919093
Vakharia, S. & Little, J. (2016). Starting Where the Client Is: Harm Reduction Guidelines for Social Work Practice. Clinical Social Work Journal, 45, 65-76. DOI 10.1007/s10615-0160584-3
Author
CHRISTOPHER B.R. SMITH, PHD is currently based at Memorial University of Newfoundland (MUN), having previously worked in the U.S. (Philadelphia), Australia (Melbourne), and at various institutions across Canada. Focused on the active involvement of people who use drugs (PUD) in the policies and programs ostensibly developed in their interests, Christopher’s longstanding research agenda is rooted in harm reduction and critical drug studies. Specifically, his recent work entails a critical examination of how substance use education is deprioritized in Canadian social work curriculum, opposition to the contested space of ‘addiction’/treatment, services for PUD in rural/remote contexts, and activism among organizations established by and for PUD.
Readers interested in helping to create a harm reduction collective, as proposed by Smith, are encouraged to reach him at cbrs1977@gmail.com.
Christopher B R Smith
