Further Reading

Tell me about needle-exchange programs and drop-in centres

Dear Mr. Peele:

I am looking for models to support a user-controlled, safe place, drop in centre for drug users in a very depressed part of our city. I am heartened by your description, "When people in given life situations cannot gain a necessary sense of power, control, safety, assurance and predictability, they turn to and rely on addictive experiences."

OK ... so is anyone in North America following a model of users helping themselves to create a safe, controled environment where they gain the necessary sense of power to improve their life situations?

Any suggestions of places that are currently in operation would be helpful to us.

Thank you,
LG Peterson


Dear LG:

I like your point of view. As you may know, a needle exchange program can be something of a basis for what you describe. That is, addicts/users are dealt with as people who are the decision-makers in their lives. The program merely offers the materials needed to guarantee their drug use is safe. In addition, hopefully the program also can provide the opportunity for the user to meet with counselors and health care workers who can offer them other services, including support for cutting back or quitting drugs altogether as the user desires.

Your model suggests that one does not even need a needle exchange in order to create a nonjudgmental "drop-in centre" which allows addicts/users to seek available help as they see the need for it. This eliminates the problems (and the benefits) of offering hypodermic syringes to users. It eliminates coercion in treatment and "denial" among users. But it hopefully can expand the internal resources of addicts to act constructively on their own behalfs.

It would seem you need to steer totally clear of drug use at the site. "User-controlled" sounds like a good idea, but needs to be fleshed out. How would you involve users and help them to organize themselves? What would you provide to draw drug users which would make the environment more constructive than drug haunts where addicts already congregate? Of course, in the deprived environment you describe, a clean, well-lit, warm/cool place with a TV and cold/warm drinks could be quite attractive in itself.

The use of safe place free of substance use for addicts has been applied elsewhere. For some years, the Addiction Research Foundation of Ontario employed the "Bon Ami Farm" as a nonmedical retreat for alcoholics in withdrawal. It was by all reports a pleasant environment which was sufficient in itself to eliminate practically all the medical complications of withdrawal sometimes encountered in hospital settings. This same phenomenon of muted withdrawal was also noted by Norman Zinberg when he visited Daytop Village, a supportive but no-nonsense residential community for heroin addicts.

Of course, another "safe house" model is provided by the R.D. Laing in the buildings he ran for individuals undergoing psychotic episodes, in which people were supported and protected while they experienced hallucinations or whatever, and from which Laing reported they usually re-emerged as whole individuals after some period of time. The phrase "Don't just do something" comes to mind, although helpers would inevitably do more than "just stand there." The menu of positive options might include some organized recreation, legal help, learning opportunities, health care, et al.

You seem to be a caring and energetic person, the qualifications I think for this effort. Your idea is a fascinating one and deserves an effort. It is certainly not illegal.

Best wishes,
Stanton