The concept of advocacy is strongly linked to the protection of fundamental rights. However, is it possible to develop an alternative perspective on advocacy that places care at the centre of its attention and analysis? Can advocacy that is ‘care-oriented’ serve as a healing force for individuals with substance use problems in neoliberal societies?
Advocacy is a much-discussed concept and is widely used in different fields of the social work profession. Advocacy in the area of substance use and addiction is closely linked to the struggles of grassroots movements, especially those of harm reduction. Despite its significant influence, advocacy for people with substance use problems remains an overlooked and undertheorised issue. The neoliberal tendencies of medicalisation and responsibilisation, as well as criminalisation, and the war-on-drugs ideology have a strong influence on policies and social practices aimed at people affected by substance use and create an unfavourable environment for the development of an advocacy discourse.
Medicalisation refers to a process in which people with substance use problems are viewed as patients who suffer from a chronic and relapsing disorder. In this context, addiction is approached unilaterally as a health issue that tends to have no definitive cure and must be treated by medical or pharmaceutical means. Medicalisation promotes an individualistic view of addiction, sidelining the social, economic, political, cultural and historical circumstances that produce it. It also maintains a social control of people with substance use problems by the health industry and a pessimistic view of their potential to quit their use of substances.
In the context of responsibilisation, both the causes and the burden of solving substance use and addiction are attributed exclusively to the individuals who use drugs. From this viewpoint, the substance users are perceived as self-destructive or irresponsible citizens. Responsibilisation isolates the phenomenon of substance use and addiction from the wider conditions that shape it, portraying it as a problem caused by people’s negative choices. The tendency of responsibilisation maintains stigma and hostility against people with substance use problems and tends to intensify in times of financial crisis and austerity.
Criminalisation is a source of oppression for people with substance use problems. It is strongly linked to the war-on-drugs ideology, which promotes law enforcement, police surveillance and control. A criminalisation and war-on-drugs ideology contribute to the normalisation of violence and the mass marginalisation of people with substance use problems, especially those who are poor or disadvantaged.
An ethics-of-care framework can provide an alternative viewpoint for substance use and addiction and act as an adequate counterweight to the above-mentioned tendencies. It refers to a range of approaches, developed by feminist scholars, that emphasise interdependence between people and the belief that caring is a normal part of life. In this context, care for people with substance use problems should not be approached as a private matter but as a public welfare concern. Within an ethics-of-care framework, advocacy should be guided not just by normative measures that unilaterally highlight the responsibility to safeguard rights but also by awareness of the value of care as a transforming and healing force for the collective traumas associated with addiction in neoliberal societies. In this context, ‘care-oriented’ advocacy refers to a perspective that incorporates ethics of care, particularly Joan Tronto’s political ethics-of-care theory. This model encompasses five elements of care – attentiveness, responsibility, competence, responsiveness and trust. Each phase can provide useful directions for the practice of advocacy in social work practice in the field of addiction.
In light of Tronto’s political ethics-of-care framework, attentiveness highlights the importance of understanding unmet needs and the differences that shape the social realities of people with substance use problems. When implementing advocacy practices, social workers must be sensitive to understanding these needs and consider that they are complex and heterogeneous. Responsibility emphasises that people have mutual duties towards each other. Such an understanding contradicts the neoliberal viewpoint of responsibilisation, which assigns blame to people with substance use problems. Competence includes not only a set of skills for advocating but also a vision for a more just society. Responsiveness encourages social workers who engage in advocacy to be on the alert for paternalistic stances and abuses of power at the expense of disenfranchised groups. The development of caring habits breeds trust, which has mutual consequences for both people with substance use problems and social workers in the field of addiction.
An ethics-of-care framework incorporated into advocacy invites social workers to approach the phenomenon of substance use and addiction beyond individual-centred, medicalised and punitive patterns of thought and social action. However, it is critical to situate advocacy within a broader theoretical and political framework. A decontextualised theoretical reference to advocacy runs the risk of turning into a technical, politically inert process. By incorporating care into advocacy practice, social workers can function as change agents for drug policies and positively impact the lives of people with substance use problems.
Zacharoula Kasseri, PhD, is assistant professor at Hellenic Mediterranean University (School of Health Sciences, Department of Social Work). She has professional experience in social services in Greece, where she worked as a qualified social worker with disabled children and disempowered families.
Is there space for a ‘care-oriented’ advocacy in social work practice with people who have substance use problems? by Zacharoula Kasseri in Critical and Radical Social Work and is available on Bristol University Press Digital here.
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