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Cet article est tiré d’une enquête sur des personnes cumulant différents stigmates sociaux (« toxico », « malade mental », « SDF », « délinquant »), visant à qualifier leur expérience de vie ainsi que ses conséquences identitaires. Le modèle honnethien de la reconnaissance s’est avéré pertinent pour rendre compte du mépris social vécu par nos interviewés dans la sphère intime mais également dans les différents mondes de relégation sociale par lesquels ils sont passés. La confrontation entre nos terrains et la théorie d’Axel Honneth montre néanmoins que loin de pouvoir associer un univers de relégation à une forme de mépris, ces différents types se retrouvent de manière enchevêtrée sur l’ensemble des scènes sociales décrites par les personnes. Par ailleurs, différentes formes de résistance identitaire sont repérables, demeurant toutefois fragiles. This article presents the main results of a qualitative study carried out among people with different social stigmas (« drug addict », « mentally ill », « homeless », « delinquent »). It aims at qualifying their life experience and its consequences on identity. The recognition model of Axel Honneth is efficient to account for the social contempt experience that the respondents lived in intimacy but also in different social relegation worlds. The confrontation between our study and Honethian theory shows that different forms of contempt coexist in all scenes described by the interviewees. In addition, different forms of identity resistance can be identified. They nevertheless remain fragile.

BACKGROUND AND AIMS: Despite advances in our knowledge of effective services for people who use drugs over the last decades globally, coverage remains poor in most countries, while quality is often unknown. This paper aims to discuss the historical development of successful epidemiological indicators and to present a framework for extending them with additional indicators of coverage and quality of harm reduction services, for monitoring and evaluation at international, national or subnational levels. The ultimate aim is to improve these services in order to reduce health and social problems among people who use drugs, such as human immunodeficiency virus (HIV) and hepatitis C virus (HCV) infection, crime and legal problems, overdose (death) and other morbidity and mortality. METHODS AND RESULTS: The framework was developed collaboratively using consensus methods involving nominal group meetings, review of existing quality standards, repeated email commenting rounds and qualitative analysis of opinions/experiences from a broad range of professionals/experts, including members of civil society and organisations representing people who use drugs. Twelve priority candidate indicators are proposed for opioid agonist therapy (OAT), needle and syringe programmes (NSP) and generic cross-cutting aspects of harm reduction (and potentially other drug) services. Under the specific OAT indicators, priority indicators included 'coverage', 'waiting list time', 'dosage' and 'availability in prisons'. For the specific NSP indicators, the priority indicators included 'coverage', 'number of needles/syringes distributed/collected', 'provision of other drug use paraphernalia' and 'availability in prisons'. Among the generic or cross-cutting indicators the priority indicators were 'infectious diseases counselling and care', 'take away naloxone', 'information on safe use/sex' and 'condoms'. We discuss conditions for the successful development of the suggested indicators and constraints (e.g. funding, ideology). We propose conducting a pilot study to test the feasibility and applicability of the proposed indicators before their scaling up and routine implementation, to evaluate their effectiveness in comparing service coverage and quality across countries. CONCLUSIONS: The establishment of an improved set of validated and internationally agreed upon best practice indicators for monitoring harm reduction service will provide a structural basis for public health and epidemiological studies and support evidence and human rights-based health policies, services and interventions.

Cet article porte sur les carrieres d’usagers de cocaine inconnus des institutions socio-sanitaires et repressives. Il presente les resultats d’une enquete conduite par entretiens semi-directifs aupres de 50 usagers appartenant a cette population cachee. Les auteurs retracent les differentes etapes des carrieres en portant une attention particuliere aux frequences d’usage mais aussi aux contextes de consommation, aux significations de l’usage ainsi qu’aux dynamiques de groupe faconnant les parcours individuels.

Asserting that medicalization is nothing but a specific form of problematization underscores both the general signification of the phenomenon and its relative commonality: it is one of many configurations of problems. In the case of addiction in France, it evolved during the late 1980s and early 1990's from a problem of drug withdrawal to one of risk reduction. The former was formulated by psychiatrists with the objective of weaning addicts off drugs. The latter was defined by public health specialists who considered that the major threat was infectious diseases caused by the injection of drugs. The traditional medicalization of addictions involves a distinction between good and bad behaviors, temperance and dependence, governing of the self and giving oneself up. On the one hand, medicalization substitutes itself to law enforcement activities or, the liberal programs of syringe and needle exchange and methadone treatment displace the repressive activities of the police.

Current approaches to drugs tend to be determined by medical and criminal visions that emerged over a century ago; the concepts of addiction, on the one hand, and drug control on the other, having imposed themselves as the unquestionable central notions surrounding drug issues and discourses. Pathologization and criminalization are the dominant perspectives on psychoactive drugs, and it is difficult to describe drug consumption in any terms other than those of medicine, or to conceive of regulation except in terms of control and eradication. Drugs and Culture presents other voices and understandings of drug issues, highlighting the socio-cultural features of drug use and regulation in modern societies. It examines the cultural dimensions of drugs and their regulation, with special attention to questions of how consumption of specific psychoactive substances becomes associated with particular social groups; the social dynamics involved in our coming to think of these phenomena as we do; and the factors that determine the political and policy responses to drug use. Adopting approaches from anthropology, sociology, history, political science and geopolitics to challenge the prevailing pathologization and criminalization of drug use, this book provides international and comparative perspectives on drug research, based on the latest research in Europe, the USA, the Middle East and Hong Kong. Foreword; Introduction: drugs and culture, Maitena Milhet, Molly Moloney, Henri Bergeron and Geoffrey Hunt; Part I Knowledge: Science, Medicine, and Discourses on Drugs: Social fear, drug-related beliefs, and drug policy, Ross Coomber; Blinding ourselves with science: the chronic infections of our thinking on psychoactive substances, Tom Decorte; Epidemiology as a model: processing data through a black box?, Patrick Peretti-Watel; Opiate addiction: a revival of medical involvement, Peter Conrad and Thomas Mackie; This is not medicalization, Didier Fassin; Drugs: a sociological blind spot? A look at the French experience, Michel Kokoreff. Part II Consumption: Cultures of Drug Use: Drug consumption: a social ritual? The examples of tobacco and cocaine, Randall Collins; Dance drug scenes: a global perspective, Geoffrey Hunt, Karen Joe-Laidler, Molly Moloney, Agnes van der Poel and Dike van de Mheen; Contemporary use of natural hallucinogens: from techno subcultures to mainstream values, Maitena Milhet and Catherine Reynaud-Maurupt; Ecstasy, gender, and accountability in a rave culture, Molly Moloney and Geoffrey Hunt; Drug use in Europe: specific national characteristics or shared models?, Frank Zobel and Wolfgang Götz. Part III Policy or Politics? The Cultural Dyamics of Public Responses: Modernity and anti-modernity: drug policy and political culture in the United States and Europe in the 19th and 20th centuries, David T. Courtwright and Timothy A. Hickman; Assessing global drug problems, policies, and reform proposals, Peter Reuter; Homelessness, addiction, and politically structured suffering in the US war on drugs, Philippe Bourgois; Knowledge and policies to reduce drug supply in France: some misunderstandings, Nacer Lalam and Laurent Laniel; The culture of drug policy, Henri Bergeron; Index.