Trust - Part one of a five part series
Scott Cameron, President/CEO
bassa Social Innovations
The opioid crisis is hitting communities across North America in alarming rates. Red Deer, Alberta has been hit particularly hard by this epidemic, positioning it as having some of the highest reported fentanyl overdose fatality rates in the province. This series, based on the five dimensions of social capital as outlined by the World Bank, will examine trust, social cohesion and inclusion, groups and networks, collective action and cooperation, and information and communication through the lens of this current and relevant topic.
Trust is a cognitive and subjective component of our everyday interactions with people and institutions around us, and the current opioid epidemic is challenging many long held beliefs, values and assumptions within the general population. The World Bank identifies three components of trust that will be explored within this article – thin trust, thick trust and the trust we have in government and institutions. In general, trust enables us to “be more tolerant of minority views, and display many other forms of civic virtue” (Putnam, 2001).
Thin trust is a term used to describe the manner in which we interact with people based on generally understood social norms and values. By the very nature of the opioid crisis specifically and the prevalence of addictions generally, an underlying assumption within the general population exists that is based on the belief that substance use is a choice. This assumption immediately challenges the social norm and value held by many, and establishes a void between people experiencing addictions and those unable to associate with the problematic use of substances. Fear of the unknown and concern for the potential of unpredictable behaviours while intoxicated, contributes to the lack of trust held for people experiencing addictions.
In our day to day lives, we generally hold a level of thin trust for the people that we encounter on a casual or regular basis. We trust that the local barista will generate our daily beverage in the manner we have become accustomed; we trust and assume that the transit driver knows where they are going and will deliver us safely to our destination; and we even trust that when we ask directions of a stranger that they will point us in the right direction. These are examples of thin trust. Imagine how we might approach these same people if we were to encounter them in the hospital emergency room while they were in the midst of passing a kidney stone or having a heart attack – we may have our reservations. While we are able to wrap our minds around the pain, discomfort and unpredictability of these people experiencing an acute health issue, our social norms and values sometimes prevent us from being able to see the trauma and pain being experienced by people using substances to help control the hurt. Addictions are a health concern more so than a social disorder. Our ability to exercise thin trust toward those affected by this disease is influenced by our perceptions about choice – as long as we associate addictions with choice, we create a judgement that allows us to disassociate.
Thick trust, however, is a term used to describe the type of relationship we experience with people known to us – family, friends and associates that we connect with on a regular basis. Our communities and networks of people are bound by a mutual respect for one another. Addictions have the ability to erode thick trust – ask anyone who has lost a brother, sister, parent, friend or colleague to an addiction. In the early stages of an addiction, it’s natural to step back and judge the behaviour of someone who is drinking too much or accessing illicit drugs “for recreational purposes”. What’s unnatural for many is the ability to exercise thick trust by engaging in conversation about what’s happening below the surface. “Not my business” is often the excuse used to remain on the periphery. It’s safer and more comfortable to remove oneself from the situation and step aside to avoid being impacted by potential collateral damage.
Thick trust is often lacking among those impacted by addictions. Through their own actions, trust tends to be an early casualty. Family members and friends are typically at a loss in understanding how to help someone experiencing the underlying causes of addictions, and see the downward spiral as a poor option for coping with pain. Unlike the family member or friend experiencing the acute pain of a kidney stone or heart attack, people showing up in emergency rooms across the country due to an overdose are often doing so alone – the alienating factors associated with their addiction have most often left them to deal with their pain in isolation. And so, the downward spiral is perpetuated.
The third component of trust necessary in the development of social capital is trust in government and institutions. This form of trust can be viewed through two different lenses – trust in the system of delivery, and trust for the people working within the systems. As a society, it can be difficult to separate the two - a poor experience in the emergency room, with a cop, or a government official can often result in the temptation to paint the entire system with the tarnished colours of that experience. In reality, our systems are filled with people committed to serving others and deserving of trust and respect. As people working within systems, addictions and the current opioid crisis are having a substantial impact on individuals dedicated to a life of service.
At a systems level, institutions, governments and agencies are struggling to get a handle on the patterns underlying the root causes of addictions while staring down the tidal wave of impacted people arriving for treatment and support. Systems like health care, policing, emergency services and social agencies are struggling to identify the appropriate leverage points to get a handle on service levels and support strategies. At this systems level, dedicated leaders are seeking to combat the negative forces that feed a drug trade designed to prey on people weakened by disassociation, lack of self-worth and mental health disorders. Trust is difficult to maintain within these systems when the systems themselves are under continual scrutiny and judgement. The challenges facing these systems are complex and multi-faceted – there’s no silver bullet.
Front line workers within these systems face the same scrutiny, while at the same time encountering life-threatening circumstances on a daily basis. We trust these people to administer life-saving interventions like naloxone, oxygen and CPR to people experiencing overdoses – and we expect that they will continue on an ongoing basis. Without much thought, we hope and trust that these front line workers have access to supports and trusting relationships within their own lives to facilitate the dedication to their profession.
At a systems level, a local non-profit is exploring the avenues available to them in restoring the health and well-being of front line workers. While the organization was established to deliver interventions and supports to those affected by addictions, and continues to do so, there is a passionate understanding for the need to provide supports and attention to the very people working within the systems of care. This blog series is intended to support this initiative, and uncover a multitude of leverage points available to individuals and systems alike to create an interdisciplinary approach.
Putnam, R. (2000). Bowling alone: The collapse and revival of American community. New York: Simon & Schuster.
The World Bank. (2013). Measuring the dimensions of social capital. Retrieved from http://web.worldbank.org/WBSITE/EXTERNAL/TOPICS/EXTSOCIALDEVELOPMENT/EXTTSOCIALCAPITAL/0,,contentMDK:20305939~menuPK:994404~pagePK:148956~piPK:216618~theSitePK:401015,00.html
The World Bank. (1998). The initiative on defining, monitoring and measuring social capital. Retrieved from http://siteresources.worldbank.org/INTSOCIALCAPITAL/Resources/Social-Capital-Initiative-Working-Paper-Series/SCI-WPS-01.pdf
The World Bank. (2013). Social Capital Implementation Framework. Retrieved from http://web.worldbank.org/WBSITE/EXTERNAL/TOPICS/EXTSOCIALDEVELOPMENT/EXTTSOCIALCAPITAL/0,,contentMDK:20461319~menuPK:994404~pagePK:148956~piPK:216618~theSitePK:401015~isCURL:Y,00.html