The notion that people can become experts on an issue through their own personal experience rather than through professional development learning, research, working closely with people who are personally affected by that issue etc. is common in the drugs field.
This empowers people who may not have professional qualifications or experience of working with people affected by drugs but have their own direct personal experience of problem drug use and may have had many peers who have been involved in drug use.
The notion is contested in three ways:
1. What experience gives insight into another person’s situation?
For example, does experience of problem alcohol use give a useful insight into the everyday experiences of someone who injects heroin each day?
The answer is complicated. There may be a useful insight into some experiences, for example feeling compelled or needing to use a substance. There may be a shared experience of fear of withdrawal symptoms.
However, there may be less insights in terms of relationships with the police and the criminal justice system or the experience of large numbers of peers suddenly dying of overdose or the stigma that attaches to people who have a heroin problem. Indeed, a person who has had an alcohol problem may hold stigmatising views of someone who has a problem involving heroin. Certainly, there is no shared experience and therefore no insight into the stigma of consuming methadone in a pharmacy; or injecting practice or injecting wounds or perhaps the experience of fear of being tested for, or diagnosed with, viral hepatitis or HIV.
2. Where there is experience, is this the same as expertise?
For example, a person may have injected heroin almost every day for years but does this make that person an expert?
For anyone who has been in this situation or lived or worked closely with someone who has been in this situation, the answer is obviously no. Despite long experience, people often have very poor injecting practice and the rate of injuries and infections, some serious and ultimately leading to ulcers or sepsis or even amputation, is high. And yet good injecting technique and practice is taught to a trainee nurse in a few short training sessions.
3. Is the experience relevant?
Although someone may have experience of, for example, using treatment services, this insight may have a ‘shelf life’ and months or years later this insight and ‘expertise’ may have no real use. In fact it may be dangerous for this knowledge to be used to evaluate service provision or to influence changes to service provision (see user involvement).
Offence and objections are sometimes raised by professionals within the field who contest that while there is useful insight to be gained from a person’s own experience, people without this personal experience can have the same insight through learning (which may involve conversation with many individuals who are affected by the issue, direct observation of their situation and circumstances as well as book learning and research) combined with human empathy.
It is sometimes contested that the useful shared insight is not that a person’s experience makes them an expert but that middle class professionals lack insight into the lives of people who are working class or people who experience poverty. They may not even ‘speak their language’. In this case, the ‘expert by experience’ may have expertise that is less to do with their experience of problem drug use and more to do with their experience and understanding of the culture and background they may share with some other people who have a drug problem (see poverty).
Some people who have had personal experience of problem substance use and work within the treatment and support sector may feel that their professional training and qualifications are undermined if they are regarded solely as ‘expert by experience’ (see peer workers).
There is concern also that this term sets people up to fail. People may defer to experience without full engagement and discussion and adequate supports may not be provided to ensure effective engagement. This may lead to tokenism or to bad experiences for people with experience of problem substance use. (See user involvement)