by Patricia Strach
A professional on a recent Substance Abuse and Mental Health Services Administration (SAMHSA) webinar that we participated in noted that stigma doesn’t just affect people who use drugs (the clients), it also affects the professionals providing services to them. We weren’t surprised. In our interviews, focus groups, and participant observation of roughly 200 professionals, we heard the same frustration, which was backed up with examples of lower salaries, less respect, and few opportunities to use professional discretion.
While researchers have shown that clients or even community members learn lessons about how government works from their direct or indirect interactions, we don’t know what effect policies have on another invested group: professional implementors. Yet professionals in substance-use disorder services—including general healthcare, drug treatment, and harm reduction (such as syringe exchange) programs—are very aware that they have a different experience from professionals working with other clients.
Substance-use disorder services, then, offer a window into how policies designed for marginalized and negatively constructed populations affect the advantaged, policy professionals administering them with broader implications for the true effects of public policy.
In our research, we find that policy implementors learn by proxy: they witness a government that does not care about people who use drugs; they experience a government that is not committed to providing positive care services to their clients and does not value the professionals who work with them; and in witnessing and experiencing together, they learn that the disadvantaged status of people who use drugs affects the benefits and burdens on the professionals who administer them too.
One treatment provider summed up the effect of extensive and proscriptive rules that punish clients at the same time they remove clinical discretion from well-qualified providers as having “less to do …with whether or not they believe the patient. It’s really how much they respect the opinion or the information provided by the clinician. So I think that stigma follows not only the clients and patients that we see, but I think they don’t always believe us.”
These lessons shape implementors’ views of government. They believe government does not care and has chosen not to take meaningful action in ways that are at odds with what their advantaged status—as counselors, nurses, doctors, managers, and executives in health systems—might suggest. They do not see government as supportive, or politics as winnable. Instead, their status as professionals allows them to compare their experience to other professionals’ and their clients’ experience with other clients’, and they recognize the unfairness in how government treats clients and professionals.
Our article, “Learning by Proxy: How Burdensome Policies Shape Policy Implementors Views of Government,” suggests that policy affects more than clients or community members. It spills over to the professionals who implement them, shaping their experience and perspective of government too. Our research offers lessons for scholars of drug policy, policy feedback, administrative burdens, and social construction of target populations.
You can read the original article in Policy Studies Journal at
Strach, Patricia, Elizabeth Pérez-Chiqués and Katie Zuber. 2024. “ Learning by Proxy: How Burdensome Policies Shape Policy Implementors’ Views of Government.” Policy Studies Journal 00(0): 1–23. https://doi.org/10.1111/psj.12554.
About the Author
Patricia Strach, PhD is Professor, Departments of Political Science and Public Administration & Policy, University at Albany, State University of New York (SUNY) and a fellow at the Rockefeller Institute of Government, SUNY. With Katie Zuber and Elizabeth Pérez-Chiqués, she examines the opioid epidemic in local communities, engaging people on the frontlines including judges, lawyers, sheriffs, service providers, elected officials, community activists, and people who use drugs and their families. She is the author most recently of The Politics of Trash: How Governments Used Corruption to Clean Cities, 1890–1929 (Cornell 2023) as well as articles published in the Journal of Public Administration Research and Theory, Policy Studies Journal, and the Journal of Health Politics, Policy, and Law. She has presented her findings to federal and state policymakers and has appeared on panels across New York State. Strach received the Outstanding Public Engagement in Health Policy Award from the American Political Science Association’s Section on Health Politics and Policy in 2020 and was a Robert Wood Johnson Scholar in Health Policy Research at Harvard (2008-2010).
Policy Studies Journal Blog 