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Putting at risk what we know: Reflecting on the drug-using subject in harm reduction and its political implications

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  • Moore, David
  • Fraser, Suzanne

Abstract

This paper provides a poststructuralist analysis of the cultural inscription of drug-using subjects in the neo-liberal discourses of contemporary harm reduction. We argue that although neo-liberal discourses downplay material constraints on individual human agency, divert policy and practice away from structural issues, limit the conception of effective strategies for harm reduction and ignore alternative formulations of the subject, they are also potentially empowering for drug users. Approximating the neo-liberal subject offers political benefits in terms of recognition, trust and legitimation, even as those values assume and reproduce understandings of behaviour, thought and sociality that fit only poorly the realities faced by many drug users. We explore this dilemma and consider three available directions in formulating the subject of harm reduction: (1) embracing the neo-liberal subject; (2) employing a more contextualised version of the neo-liberal subject; and (3) adopting alternative notions of subjectivity, extending the critique of the neo-liberal subject to all citizens, not solely drug users. To clarify some of these issues surrounding this strategic process, the paper considers another field in which struggles over the nature of the subject have been conducted--feminism. The intention is not to resolve the question of the most appropriate subject for harm reduction, but to sketch the political consequences of adopting particular models of the subject as a stimulus to further discussion and debate.

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  • Moore, David & Fraser, Suzanne, 2006. "Putting at risk what we know: Reflecting on the drug-using subject in harm reduction and its political implications," Social Science & Medicine, Elsevier, vol. 62(12), pages 3035-3047, June.
  • Handle: RePEc:eee:socmed:v:62:y:2006:i:12:p:3035-3047
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    References listed on IDEAS

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    1. Stimson, Gerry V., 1995. "Aids and injecting drug use in the United Kingdom, 1987-1993: The policy response and the prevention of the epidemic," Social Science & Medicine, Elsevier, vol. 41(5), pages 699-716, September.
    2. Moore, David, 2004. "Governing street-based injecting drug users: a critique of heroin overdose prevention in Australia," Social Science & Medicine, Elsevier, vol. 59(7), pages 1547-1557, October.
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    1. Mayer, Samara & Jenkins, Emily & Fairbairn, Nadia & Fowler, Al & McNeil, Ryan, 2024. "“I'm just searching to get better”: Constructions of treatment citizenship on injectable opioid agonist treatment," Social Science & Medicine, Elsevier, vol. 348(C).
    2. Houborg, Esben & Mogensen, Sif Ingibergsdottir & Kronbæk, Mette & Fahnøe, Kristian Relsted & Kappel, Nanna & Johansen, Katrine Schepelern, 2025. "Care in an opioid substitution therapy daycentre," Social Science & Medicine, Elsevier, vol. 369(C).
    3. Ezell, Jerel M. & Walters, Suzan & Friedman, Samuel R. & Bolinski, Rebecca & Jenkins, Wiley D. & Schneider, John & Link, Bruce & Pho, Mai T., 2021. "Stigmatize the use, not the user? Attitudes on opioid use, drug injection, treatment, and overdose prevention in rural communities," Social Science & Medicine, Elsevier, vol. 268(C).
    4. Sinnisa Zovko & Niksa Dubreta, 2020. "A Sociohistorical Overview of Harm Reduction Development in Croatia," Interdisciplinary Description of Complex Systems - scientific journal, Croatian Interdisciplinary Society Provider Homepage: http://indecs.eu, vol. 18(1), pages 57-71.
    5. Fleming, Taylor & Collins, Alexandra B. & Boyd, Jade & Knight, Kelly R. & McNeil, Ryan, 2023. "“It's no foundation, there's no stabilization, you're just scattered”: A qualitative study of the institutional circuit of recently-evicted people who use drugs," Social Science & Medicine, Elsevier, vol. 324(C).
    6. Aysel Sultan, 2022. "‘What’s the Problem Represented to Be?’ The Place and Wellbeing of Young People in Azerbaijan’s Drug Policy," Child Indicators Research, Springer;The International Society of Child Indicators (ISCI), vol. 15(4), pages 1163-1178, August.
    7. Fraser, Suzanne & Moore, David, 2008. "Dazzled by unity? Order and chaos in public discourse on illicit drug use," Social Science & Medicine, Elsevier, vol. 66(3), pages 740-752, February.
    8. Moore, David, 2009. "'Workers', 'clients' and the struggle over needs: Understanding encounters between service providers and injecting drug users in an Australian city," Social Science & Medicine, Elsevier, vol. 68(6), pages 1161-1168, March.
    9. Gowan, Teresa & Whetstone, Sarah & Andic, Tanja, 2012. "Addiction, agency, and the politics of self-control: Doing harm reduction in a heroin users’ group," Social Science & Medicine, Elsevier, vol. 74(8), pages 1251-1260.
    10. Holt, Martin, 2007. "Agency and dependency within treatment: Drug treatment clients negotiating methadone and antidepressants," Social Science & Medicine, Elsevier, vol. 64(9), pages 1937-1947, May.
    11. Elizabeth Stone, 2017. "Is There “Hope for Every Addicted American”? The New U.S. War on Drugs," Social Sciences, MDPI, vol. 7(1), pages 1-20, December.

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