Episode 7 Introduction To Harm Reduction Watch Now https://youtu.be/0xR3fVSveT4 Listen Now Episode 7 We begin to open up some delicate topics around different treatment approaches such as Abstinence, versus newer principles that are emerging within recovery, called Harm Reduction.
Topics:
Select Quotes There are no two addictions that are the same, so there is no one equation that you can just plug an addict into and expect only positive outcomes. So we get into this more open and understanding world where different intervention strategies are geared towards improving the overall wellness and quality of life for the individual rather than focusing on these hard definitions of what it means to be in recovery or what it means to be sober. Clinton Nicholson, MA, LPC, NCC - Chief Operations Officer Episode Transcripts Episode 7 Transcript [Music] all right welcome back to another episode of finding peaks um brandon burns host uh ceo of peaks recovery centers joined here today again uh with my friend here jason friesma chief clinical officer and my other friend uh clint nicholson chief operating officer and a backup friend yeah i'll take it yeah yeah yeah it's a heavy hitting episode before we yeah dive into these yeah all right feelers aside um again welcome back uh so today we are gonna try and start a series of episodes about or the differences between the grayness of delivering services that are abstinence-based as approach but also starting to inform the idea and talk about it self-harm or self-harm excuse me harm reduction principles would be the opposite absolutely harm reduction principles um and the approach to care and what that looks like so within this industry it's a seemingly contentious topic because of all of the grayness that exists within it and say when it's right to follow the abstinence lens or when it's right to you know say you have a heroin addiction for example to allow for time uh a year or two to pass before starting to entertain maybe what it would be like to have a drink um and uh so we're gonna start i think from the ground up as an important aspect of this to create some definitions around this and as we go through this um because it's a heavy hitting topic we would love to hear questions feedback comments concerns and anything that we can help bridge any gaps that might be experienced on the on the user's end in that regard so going back now i think to 1935 1938 again and there somewhere where the big book was written that informed the room's individual wellness and abstinence um jason t us off history how did we get here okay uh how did we get here so historically um well really back in the 1930s there was really no treatment for substance use there was treatment of the symptoms of having other medical problems and so really people ended up in the hospital for a month got out went right back out on the street no resources of course uh no real social work uh options no real uh possibilities and so um from that history uh developed the the aaa model and the founding fathers of aaa in writing the a.a big book and really um from that came this this really uh well the 12 traditions and the 12 steps from aaa which really encouraged people to begin to work a recovery process and somewhere along the way there uh came coins uh i don't actually know the history of the coin um to be honest with you and where they where that entered into the aaa process but where um a metric of measurement was how long somebody was free from their well from drinking and uh and then down the road even further after that came from drinking and drug use and uh and that was uh this token became um something critically important to strive for to gain 30 days of sobriety uh to gain two months and three months and six months and nine months and a year and then 18 months and then every year after that and celebrating that indicating that i have not taken any drink and had or had any drug in this amount of time and on top of that then our profession formed or began to treat uh substance use kind of following a similar model where where the entire goal of substance use treatment was to get somebody clean and sober and a measurement of success with that would be for the rest of their life never used another drug what's really nice about that model is it's really pretty black or white uh black and white um you're either you're either doing it or you're not doing it you're either putting heroin alcohol math coke into your body or you're not and if you're not you're successful and if you are you're not successful and you have to start over uh with going down the journey of getting your coins and and again it creates the unintended consequence of that or the maybe the intended consequences it's really clear black and white if you use again you're off track and you have to start over and if you don't use you're being successful however that black and white thinking it does create a little bit a a thing that weaves its way into the a culture is um coming out of uh alcoholism you have to admit that you are an alcoholic you have to say i am an alcoholic and my life is unmanageable and um in saying i am an alcoholic it began it began what we now know with with the emerging research on shane it's a little bit well shaming to say i am and then putting anything after that that that is less than uh kind to oneself that's a little bit of a shame message that that i am this and so the undependent consequence i guess of of kind of having an abstinence-based uh thinking or mentality is that well i am this and i need to accept that and since i am this it's kind of this unchangeable part of me that i'm an alcoholic today and in 10 years i'll be an alcoholic whether or not i have anything to drink and again it it it served it has served and is serving a huge and important role in lane coming from nothing this has been incredibly useful and helpful in um gaining sobriety uh or for people to gain sobriety and gain in and work a program that helped them step out of using um i would say two out of that tradition well came the 12 traditions which really talked about this aaa thing nobody can profit from it nobody runs it the meetings are self-supportive um and it really built uh this amazing community of people that attended a meetings and and began to get sober um so it's to me like when i look at aaa honestly as an outsider it's this really interesting contrast that like there are there's this aspect of aaa that does set up um this like all or nothing mentality but on top of that there's this amazing community and culture that that brings people up and brings people within and nurtures them through through early recovery and so i don't know there's just this contrast there and and i find that to be really interesting and curious but anyway that's where that's where kind of this where an abstinence-based model came from it it came from a grassroots uh up origin has a grassroots origin story and it came from uh people getting together in community and holding each other accountable to stay sober yeah one of the things that i've seen or that seems to be commonplace within our industry uh especially within the past few years though it's softening is there what manifested out of that is that there is this sort of moral deficit that's having and we haven't generally coined it as in the science scientific terms as a craving state that's driving those um addictive behaviors um full stop and then so when we think about somebody who's using opioids then you have the um you know the invention and brought to market suboxone and sublicate and all of these other components to it but there was this immediate rejection from an abstinence-based culture it felt like especially you know coming out of the rooms that oh well now you're just using another substance and it seems to bring back that sort of shaming component of it that you're different and it's not the same and true recovery looks like this but and this is also where we're trying to balance for the viewer here the transition about the education of abstinence and then how we get to something called a harm reduction model in all of this and how do we do it amicably and how do we preserve both because both are important in approaches to recovery journeys but it's no longer true in the sense of things at least for me it feels like that one way is the only way and so in sort of lightly bridging that gap from what you described brilliantly there and thank you for the absent side of things let's start with sort of a ground-up definition of what um harm reduction looks like well i think um yeah great description of abstinence-based and i you know when we talk about the 12-step model and aaa and the big book and anc and all of those uh different organizations i think it's it really is a story of unintended consequences because the other part of um what happened with aaa is it what it is it's about addicts helping addicts right peers helping peers and because that was the only treatment for so long that actually helped to start shape addiction treatment in general where addiction treatment became very very different from mental health treatment so we're uh in to be uh you know to be perceived as an effective addiction counselor uh the it was really about are you an addict or in recovery or not versus do you have a degree and have you been trained in these skills and then these foundational these mental health foundational principles um and so there was a big disparity between the mental health world and the addiction treatment world and now that disparity is definitely being that bridge is being closed very very quickly because i think there's an awareness now that we've uh as our understanding of addiction is more sophisticated and our approaches to mental health become more sophisticated i think that we ended up with something that looks more like the harm reduction model which takes into account this a much more much more of a mental health approach to addiction treatment which is this idea that you need to meet your client where they are like so wherever a person is in their willingness and ability to change that is actually where you meet the person and then that is where you develop the intervention strategies to support that person versus in an abstinence-based model it's either you're going to quit everything or you're not going to be a client or you're not going to be successful versus in a in the harm reduction model it's much more of a spectrum where it recognizes that i may be an alcoholic and i but i may not be ready to quit drinking however i want to do something to make this less impactful on my life to make less of a negative impact on my life and so that's where harm reduction comes in and it's uh a good example of the harm reduction model is like a needle exchange for iv opiate users or methamphetamine users it's the this idea that you know these addicts may not be ready to quit their substance at the same time there are ways and interventions and strategies that we can support them we can support families and we can support most overall the community by providing them with clean needles by mitigating the amount of like bacterial infection and infectious diseases that spread within the community to help eliminate some of the burden on the on the medical field and trying to limit the amount of emergency room visits that people have to go into so it's a much more it takes a much more broad spectrum approach and it really does focus on the idea of in any form of mental health treatment you have to start with where the client is in their readiness and willingness to change and if you start above that it's the options or opportunity for success are greatly decreased or diminished but i think the the word i would put in there with the needle exchange is you meet people where they are that's like the definition of empathy right it's saying i acknowledge that this is where you are and you don't need you know to put the drugs down to receive some care and some compassion um we'll just we'll be right here with you right and and really it kind of when you were talking about um the history of good substance use counselors had to kind of come from an addiction background in their personal life really what studies have found what's way more predictive is the empathy the capacity for empathy of the clinician not what their background is and what what's behind them and and i think that's the link uh that you're talking about without harm reduction absolutely and i think the irony is you would expect the empathy to be greater from to go from addict to addict however what i think a lot of times happens is it becomes sympathy right because that addict who's in recovery looks down upon that other person and recognizes that they're in pain and that feels as though they have the path to give them to to get better versus actually meeting the client where they are and saying all right what is your we need to create a path together you know like your path is going to be different than my path is going to be different than this next person's path in this next person's path you know that is the complication of uh their of addiction there are no two addictions that are alike and so there's not one equation that's going to help uh add it that you can just kind of plug an addict into and expect a positive outcome so we get into this more open gray world of um different intervention strategies that are much more geared towards improving the the overall wellness and um quality of life of the individual rather than focusing on these sort of hard definitions of what it means to be in recovery or what it means to be in sober absolutely and just putting on my ceo hat here and building a little bit of tension into the conversation about this is about how this industry behaved in this transition it out of the gates out of the late 80s started charging people an insurance company thousands and thousands of dollars for treatment through the aaa model and so it created this unnecessary tension between something that was by itself peer-driven sophisticated in its approach and free from the very beginning and so it started to make treatment look kind of silly because we're just charging money for something that is available to anybody and everybody with a willingness to change right in that regard and so this industry you know when you when you go to other it's still happening today when you go to people's websites they'll say something like we're providing a holistic model of care here but we're abstinent space that is not holistic i mean full stop and it doesn't allow for an industry that really needs to through a treatment through the science of things to approach the individual and meet them strictly where they're at and it puts this unnecessary pressure i think on family systems and i think in my experience of it that's kind of put them on their toes like if johnny comes home and flinches in the wrong way then it's all for nothing and it's not successful and it's created this really unfortunate black and white language that i think distances us from the individual who's really struggling um in a really significant way and so i just wanted to you know sort of bring that in and up up front center to honor the traditions the 12 steps the rooms and the meetings that this industry did something really inappropriate and it missed a great opportunity to work with those programs and then also do something more significant along the lines of the harm reduction model in meeting people where they're at and then utilize its strength as an industry to help bridge those gaps and ensure different conversations and insights into um you know the suffering that comes about through addiction but i love the mental health piece as well to it so um and just curious too in your guys's time here within this industry you know what aspects of working within addiction treatment have you seen you know maybe inconsistencies as an abstinence-based approach or you know the thriving of a harm reduction approach or missteps within a harm reduction approach as we you know bridge as an industry um or anything maybe more to that we can we know what the industry's done wrong here or maybe even the better question is what do we see it doing right now well i i think the issue is that there's this there are camps right right like yeah i mean i've done this for so long like i've been asked hundreds of times if i'm an addict by clients coming in and uh i have kind of a lengthy response i give to that when i'm feeling a little more curt or angry i i say this is the only field where that's asked like i don't my colleagues who do domestic violence treatment aren't asked if they beat their wives like it's literally the only spot where it's asked like it's like a litmus test like the only way you have anything valuable for me is whether if you have a similar experience to me um and to me that is that that model of like um well that's less charitable because i think what people were asking is like i need empathy i need somebody to just sit with me in this like i need help and i need hope um and so once i learned how to deliver that message like i could quickly move beyond like whether what my own personal history is or not so um that that's always been a weird tension for me i don't know if that answers your question brandon but yeah i think i think that's a a really interesting point and um you know there's as far as my experience has primari primarily been in the harm reduction field actually so i've worked in uh medication assisted treatment for a really long time and had a lot of exposure with that and i think that that's a whole another topic that we'll address at some other point um but i so the the what i like about the harm reduction model personally is that it actually because it's a spectrum it includes abstinence it recognizes that there is a moment in time where abstinence is not only important but it's vital to the success and the well-being and the stability of the individual it just doesn't insist upon it right away it doesn't and say that this is the only place where we're going to start and then this is where we're going to end up it recognizes that the journey is going to be wild and crazy and they're going to be relapses and they're going to be complications and they're going to be triggers and there and there's going to be maybe multiple treatment episodes in order for somebody to really grasp what's going on but what it does by by having that openness and that ability ability to sort of expand and and be more creative in its navigation it really does what jason talked about at the very beginning it decreases that shame like it doesn't reiterate this idea that if i do these 12 steps and i'm sober for 90 days and then i relapse i have failed in my treatment it doesn't have that option it realizes that things life is more complicated than success and failure and that failure is an opportunity for growth so i really so for me that's what the most exciting aspect of harm reduction is i i think as far as what the industry or the harm reduction field may be missing is their ability to communicate that message effectively yeah i just think that it's been i don't know that people really recognize and understand what harm reduction actually means and how it how it impacts and helps people i think that it a lot of times people just feel like it's an excuse to you're just allowing people to still use drugs so you're not helping them at all and not really um kind of changing or adapting people's lenses to better understand exactly what it means to be in recovery and what it means to be helped yeah absolutely and i like and i love the idea too the concept of you know it having different starting points i think we talked about it several hours ago episodes ago we also talked about being on a track and everybody kind of doing their own thing directionally focused of course but i think you know when i run into you know clients as well too when we're talking about things like the 12 steps you know secular folks are going to have a resistance to especially steps two and three and finding higher powers and that sort of thing but i feel like you know not often talked about but the bridge in there is the harm reduction principle allows us to see the steps not in so much black and whiteness but as opportunities for exploration into different things whether you know it's a buddhist mindset or a buddhist approach to care um uh the dharma um in that regard and so it feels like when we start sort of you know bringing them together you know contextually and then and in practice we're actually getting a lot more out of both flavors and i think that's a really exciting piece and that this industry if it can move from the camps and start bringing its tents closer together and stand outside and start a fire together we probably get a lot closer to something meaningful and help bridge this gap in a really significant way and you know for me personally that's just something i i would love to see embraced in this industry and it's also something that um and why this conversation is so important right now um and as we go through these next few episodes so um you know with that said any any closing words before we get a little bit more uh vocal about this and insert ourselves and be vulnerable in the topic well i think the only thing i wanted to add after what you just said is you you mentioned the camps and really it's way more of a venn diagram if we can get out of our camps there's a lot more like especially initially like helping people get out of their immediate suffering like who doesn't want to do that like there's a lot more common ground there and it's pretty fertile i would say yeah yeah again i think for me as a clinician it's exciting to to see the opportunity for what this could mean for the field of addiction and how this really expands our expands the ability and capacity for us to be able to help people not only more effectively but more of them so i'm really for me it's exciting to be a part of this conversation and it is yeah moving forward i anticipate the vulnerability will be um tough to navigate at times and there may be some i don't know some very hot topics that get brought up and people might feel burns but i just for me i think the the important thing is that having this conversation regardless is all about helping people it's all about being able to provide a level of care and treatment that helps addicts live better lives absolutely so as we move forward um we just want to recognize there is an absolute sensitivity to this uh topic but it's a sensitivity um that's worth exploring and all of this so if we say things in you know our future episodes and so forth that are discomforting or did you mean to say that um please ask questions send your comments and so forth so that um we can continue to support the discussion and make clear what we're trying to say about these things moving forward so thanks again for joining us if you've only joined us by video in the past um i'm hoping to get into spotify download our podcast um you can go to peak's site as well too to find our video and podcast sessions and so forth there's just plenty of ways to listen to us in that regard and so find us and thanks for being with us and we'll see you soon