Ferry’s Corner: Drugs are not the (only) Problem

In the 1980s, Norman Zinberg described the Drug, Set, Setting-model as a way to better understand problematic drug use. The model may be old, but it is still very relevant today. Rather than appointing drugs as the central problem of addiction, it assumes that the drug using behaviour is influenced by the interplay between the drug, the mindset of the person and the social setting in which the drug use takes place. That is precisely why I find it so useful in harm reduction and in my work as a social worker. 

In Zinberg’s model “Drug” refers to the substance itself: type, dose, purity and combinations. As a social worker, one can ask neutral, factual questions about the drugs and give information about possible risks. For example by saying: ‘I’m curious about what you use, maybe I can give you some practical tips.’ 

“Set” is about the person’s state of mind, their expectations, their health and experience. A simple question can provide a lot of insight: ‘When you use drugs, when (or where) do you feel most comfortable?’ 

“Setting” revolves around the environment: location, atmosphere, company and safety. Can your client use drugs in a safe, low-stress place? And can you help make that possible? A question to ask your client can be: ‘Do you have a place where you feel comfortable when using drugs? How can we support you in that?’ 

The goal for the person is to achieve a healthy balance between drugs, set and setting. If that balance is lacking, there is a greater chance of stress, discomfort or a bad experience.  

This model changed my view on drug use. Whereas I used to think that drugs always lead to addiction, I now know that it often has to do with the mindset and environment in which someone uses drugs. It is a nice thought that, as a care worker, you can have a positive influence on this. 

Happy holidays everybody! 

Ferry Barendregt, Mainline trainer

Trainer Ferry Barendregt gives trainings across the country on behalf of Mainline about drugs and drug use.