East Bay HIV/STI Case Management Manual

Author: Braunz Courtney

The War on Drugs resulted in an immense growth in court caseloads and the prison population. It focused on small-time drug dealers, who were generally poor young Black males from the inner city. Ultimately, the prison population doubled due to the arrest of drug dealers and their customers. 

More nonviolent drug offenders were incarcerated, but the policies failed to decrease the rates of drug use across the United States. Criminalisation of drug users, excessive levels of imprisonment, and punitive sentencing practices—including mandatory sentencing, the death penalty, and enforced drug detention centers—are some of the unintended negative consequences of this 50-year policy, with direct impact on the vulnerable, poor, and socially excluded groups, including ethnic minorities and women. As case managers, we can play a role in addressing some of the harm caused by the War on Drugs. 

The first step in supporting our clients who use substances is acknowledging their expertise in their own lived experience as people who use drugs (PWUDs). With this approach, grounded in cultural humility, we can begin to assess and understand our clients’ goals, preferences, and needs around their substance use and HIV. Information to gather from clients includes:

• Substance use history, to identify the client’s reason and/or rationale for drug use and understand what initially led to their drug use
• Perceived severity of their past and present drug use 
• Perceived benefits of drug use, including perceived benefits to their the mind, body, and soul
• Their goals around drug use, to assist you in helping navigate them to get there
• Challenges they have experienced as a result of their substance use 
• Lessons they have learned over the history of their substance use, and how that may be applied in future decision making for continued use or for their individualized recovery plan
• Their own definition of recovery and what that would mean for them
• How their substance use alters, hinders, or helps with other social determinants of health, e.g., housing, employment, mental health, physical health, and social interactions with loved ones, friends, or acquaintances 
• How their use of drugs negatively or positively impacts those closest to them and the environment they are a part of 

Working with and/or employing PWUDs

At your agency, you may have both clients and coworkers who have experience using drugs. Employing drug users demonstrates a program’s commitment to improving the health and human rights of people who use drugs. 

In addition, employees who use drugs can become excellent role models for other drug users in their program. Drug users are often the most effective public health messengers for reaching other drug users. Also, hiring drug users provides agencies with direct access to valuable knowledge about the needs and practices of their target populations.

Being gainfully employed in jobs that are valued and recognized as socially important contributes directly to improved self-esteem. Working in a structured environment allows drug users to gain important skills that can facilitate future entrance into other jobs. Working in community-based projects is integral to increased feelings of belonging and contributing to a community. Employing and organizing people who use drugs contributes to civic engagement and political responsibility for drug users and the organization itself.

Examples/practical applications

• Motivational interviewing 
• Strengths-based approach 
• Trauma-informed care 

Important links/resources: 

• Harm Reduction Therapy Center 

References: 

Cheryl White, Harm Reduction at Work – A Guide For Organizations Employing People Who Use Drugs.