BackgroundThe perspectives of people who use drugs are critical in understanding why people choose to reduce harm in relation to drug use, what practices are considered or preferred in conceptualizations of harm reduction, and which environmental factors interfere with or support the use of harm reduction strategies. This study explores how people who inject drugs (PWID) think about harm reduction and considers the critical imperative of equity in health and social services delivery for this community.MethodsThis community-based participatory research study was conducted in a Canadian urban centre. Using a peer-based recruitment and interviewing strategy, semi-structured qualitative interviews were conducted by and with PWID. The Vidaview Life Story Board, an innovative tool where interviewers and participant co-construct a visual “life-scape” using a board, markers, and customized picture magnets, was used to facilitate the interviews. The topics explored included injection drug use and harm reduction histories, facilitators and barriers to using harm reduction strategies, and suggestions for improving services and supports.ResultsTwenty-three interviews with PWID (14 men and 9 women) were analysed, with a median age of 50. Results highlighted an expanded conceptualization of harm reduction from the perspectives of PWID, including motivations for adopting harm reduction strategies and a description of harm reduction practices that went beyond conventional health-focused concerns. The most common personal practices that PWID used included working toward moderation, employing various cognitive strategies, and engaging in community activities. The importance of social or peer support and improving self-efficacy was also evident. Further, there was a call for less rigid eligibility criteria and procedures in health and social services, and the need to more adequately address the stigmatization of drug users.ConclusionsThese findings demonstrated that PWID incorporate many personal harm reduction practices in their daily lives to improve their well-being, and these practices highlight the importance of agency, self-care, and community building. Health and social services are needed to better support these practices because the many socio-structural barriers this community faces often interfere with harm reduction efforts. Finally, “one size does not fit all” when it comes to harm reduction, and more personalized or de-medicalized conceptualizations are recommended.
Previous research in sociology has shown that what is considered as sanity or mental health is described according to a social ideal. Mental health problems have been theorized as a deviance from such norms. Depression, in particular, has been the object of sociological contemplation due to its divergence from a Western social normativity focused on functionality, adaptation and productivity. This research adds to this body of work on depression as a deviation from social norms. It seeks to address a gap within the literature, by exploring the ways in which the “post-depressive” state may be defined in accordance with social norms. As such, it analyzes the links between “post-depression” and normality, from the perspective of individuals having lived with depression. 46 semi-structured interviews were conducted with Canadians individuals who have experienced depression. Results from our content analysis show that the absence of depression was often synonymous with normality and characterized by the following dimensions: a positive attitude; the potential to take action; functionality and performance; self-management; a positive relationship with others; and the notion of meaningful projects. Our results show that participants do not define the absence of depression following psychiatric or clinical indicators, as recorded in the DSM, and that they do not consider it to be a return to an anterior, pre-depression, state. Rather, post-depression is idealized, perceived as a state of unfailing conformity to social expectations and norms.
Findings underline trends in Quebec clinical practice characterized by an increase in the number of psychologists identifying cognitive-behavioral approach as their primary self-reported theoretical orientation.
Comment les trajectoires de soins des jeunes qui sont psychiatrisé-e-s influencent-elles leur transition à la vie adulte au Québec ? Les jeunes passent maintenant à l’âge adulte dans un contexte social et économique caractérisé par une croissance du travail non régulier et la transformation de la structure familiale. Nous argumentons que ce passage des soins pour enfants aux soins pour adultes vécu par certain-e-s, vulnérabilise cette population déjà marginalisée en exacerbant les défis qu’elles et ils vivent à travers cette transition. Notre analyse d’entretiens menés avec des intervenant-e-s qui travaillent avec ces jeunes montre que leurs trajectoires de soins exacerbent au moins en partie les défi s auxquels elles et ils font face. C’est une réalité que nous observons notamment au niveau de leur accès au logement, de leur recherche d’emploi et de leur capacité à construire des projets étalés dans la durée. Nous discutons la façon dont ces expériences influencent la recherche de stabilité et la recherche d’autonomie propre à leurs parcours de vie.
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