As a 20-year-old undergraduate student who had limited familiarity with substance use beyond alcohol, the most formative aspect of my education was an internship at a harm reduction program for people in my college city who injected drugs. Flash forward more than 15 years, and I realize this was a first step toward discovering my life’s calling: as a social worker advocating for drug policies grounded in science, compassion, health and human rights.
Inspired to pursue a career in social work based on my affinity for the harm reduction framework, I’m continuously surprised by the difficulties social workers encounter in upholding professional ethics that parallel a harm reduction philosophy. These challenges seem especially and heartbreakingly salient while navigating the intersections of drug policy and child welfare systems.
The National Association of Social Workers (NASW) lays out the profession’s mission, basic values, ethical principles, and ethical standards in our Code of Ethics. In my application for my master’s program in Social Work, I observed that the defining concepts of social work are deeply compatible with those of harm reduction.
Social work is committed to recognizing people’s fundamental right to self-determination, bolstering inherent strengths, honoring human relationships and striving for social justice, with particular attention to those most marginalized by inequities. Harm reduction is all about humanizing and demystifying substance use and other behaviors that engender risk—and promoting the autonomy, dignity and empowerment of people who use drugs. It’s a great fit.
Social workers are ostensibly expected to uphold our ethics regardless of our practice setting, and with whatever populations we serve. We have guidelines for recognizing and resolving ethical dilemmas and seeking supervision and consultation when we need support in doing so. We are counseled to distinguish between matters of legality and ethical judgement, and trained to scrutinize and actively counter our personal biases. As a matter of professional fellowship and competence, we’re encouraged to hold one another accountable to standards that are designed to help us deliver non-judgmental services with deference to client autonomy.
Surely most of us do our best, but this also begs the question: If we’re being honest with ourselves and with our colleagues, in what contexts are we consistently falling short of these ideals? How do some of the systems and institutions where we do our work require us to ignore the tenets of our field?
In my experience, drug use—especially by people who are pregnant or parenting—is a major factor that tends to derail our professional, ethical judgment and compromise our faithful social work practice.
In many cases, social workers with admirable intentions are the face of interventions that are overtly punitive .
We’ve come a long way in recognizing problematic substance use as a health issue, but it is still often misconstrued and stigmatized as a matter of poor parenting. Parents who use drugs, even in the context of diagnosed substance use disorder, are often explicitly or implicitly branded as reckless or selfish.
This attitude is used to justify a spectrum of child welfare and/or law enforcement involvement—ranging from what is often construed as benign assessment for service eligibility to facilitating permanent family separation. In many cases, social workers with admirable intentions are the face of interventions that are overtly punitive or simply perceived to be so.
Either way, and even delivered in good faith, these “services” can be intimidating, stigmatizing and traumatizing to parents and children. They can do more harm than substance use in and of itself.
In Colorado, where I practice macro-social work as a drug policy reform advocate, child abuse is legally defined in part as “any case in which a child tests positive at birth for either a schedule I controlled substance … or a schedule II controlled substance … unless the child tests positive for a schedule II controlled substance as a result of the mother’s lawful intake of such substance as prescribed.”
A provision that looks so objective on paper—either a baby tests positive or they don’t—profoundly ignores reasonable scientific standards and disregards the complexities and realities of people’s lives. Notwithstanding that toxicology screenings on newborns are notoriously unreliable and that testing practices are often arbitrary and discriminatory, the apparent simplicity of the provision actually exposes a deep-seated bias against parents who use drugs.
Despite denoting an exception for people who take certain medications, in practice the positive test threshold still facilitates stigma against many who are legitimately using methadone, for example—and certainly creates problems for those who access medication assisted treatment through back channels, when they need it to appropriately manage their opioid dependence during their pregnancy but are reluctant or unable to get it directly from a doctor.
In such cases, pregnant people are doing their best to adhere to a medical standard of care—hardly abusing their child. And although medical and recreational marijuana are legally available in the state, this definition includes no allowances for those who use it medicinally, even with a doctor’s recommendation.
Using drugs and caring for a family are not mutually exclusive.
Moreover, objectively, while substance use during pregnancy may raise legitimate health concerns, it does not necessarily reflect that a parent is harming their child. And even when problematic substance use raises concerns about a child’s well-being, we only reinforce stigma and alienate families by equating evidence of a health challenge with abusive behavior.
Social workers—in hospital treatment teams, and peripherally or directly as part of the child welfare system—are implementing the law and perpetuating this problem.
As I’ve written previously, social workers have a responsibility to call attention to the tension between our professional ethics and common attitudes, policies and practices put forth in the name of “child welfare” and “child protection.”
It is an abomination to our mission when we embody or pay passive witness to biased attitudes and policies fostering conditions that further marginalize pregnant and parenting people who are already uniquely stigmatized because they use drugs.
I’ve found an avenue to push back on this with allies in the Colorado Coalition to Protect Children & Family Rights. Our mission, based on 10 simple principles, is to advocate for humane, public health-oriented policies for families affected by substance use. Our principles are focused on, but not unique to, Colorado, so we hope they resonate with others doing similar work elsewhere. Our current priority is removing the toxicology test provision from the definition of child abuse in our state.
Existing and proposed “child welfare” policies are disingenuous, oxymoronic and unjust when they hinge on bias against people who use drugs. Those of us who genuinely care about child welfare must start by openly acknowledging and boldly asserting the fact that using drugs and caring for a family are not mutually exclusive.
Conscientious social workers must leverage our extensive representation in child welfare and related systems to hold each other accountable to our professional values and reform the practices that undermine our competence, subvert our ethics and ultimately harm our clients.