The New School in NYC, December 1-3, 2017
by Andrew Tatarsky
Day 1 brought together a diverse group of 55 spirited clinicians from five countries and eight US states to explore and expand the application of harm reduction principles to helping people with problematic drug use and other risky behaviors.
We explored the opioid, other drug and overdose crises we are facing and the limitations and dangers of the dominant addiction as disease-one path to recovery narrative and authoritarian “tyranny of abstinence-only” that pervades treatment and society more generally. We considered the social and political context of criminalization, stigma and diseasing of drug users as it impacts on the psyches and social countertransference of helpers, the experience of being a drug user and the catastrophic impact on the lives of drug users, their families and their communities.
Harm reduction was explored both as a social movement to create a new compassionate, evidence-based drug policy toward drug use and what we call addiction as well as a framework for setting up helping relationships and effective public health strategies for saving lives, promoting health and helping people begin moving in positive directions where they are ready to begin. We looked at the therapeutic implications of the core harm reduction principles: accepting “any positive change” as success, radically starting where people are around all stages of change and positive change goals and working collaboratively to support and empower people to discover their optimal paths to positive change.
At the end of the day, these are some of the ideas participants were thinking about: harm reduction offers radical acceptance, addiction is meaningful and related to dissociated parts of the self that live in the addictive experience, its hard to hold all the parts of the self in ourselves and the people we work with, when thinking about how to treat my patients I am thinking, “how would I want myself or my loved ones to be treated?, how powerful acceptance and exploration of meaning, accepting all the parts of ourselves, can change a lot of lives, compassion toward the patient, the empathic relationship, thinking of “addict” as a social construct, how do I make sure my own biases don’t get projected in how I see the “addict”?, in the therapeutic relationship we need to separate therapist goals from the patient’s goals, several people were very moved thinking about the treatment trauma of punitive, abstinence-only one-size-fits-all treatment, recovery starts where you say it does, “Come as you are” (Jeannie Little) speaks to the authenticity that is at the heart of the work.
Day 2 began with an exploration of the relationship between trauma and risky behavior and the “addictive experience”. We discussed what trauma is, the impact of trauma on one’s emotional experience, sense of self, difficulties connecting in relationships and the turn to substances and other activities to cope, survive, shore up faulty capacities to regulate and manage feelings.
Day 3 was focused on learning the skills and strategies of IHRP. There were practical demonstrations by Andrew and Jen and skills building role-plays for participants. We began with an overview of mindfulness in its many forms considering many different teachers views on the subject. Ronald D. Siegel defines it simply as awareness with acceptance. We explored the application of mindfulness to all aspects of the behavior change process: cultivating an attitude conducive to positive change, dis-identifying from the harsh inner critic, countering shame, guilt and self-attack, assessment, information gathering, exploring multiplicity and ambivalence, “standing in the spaces” (Bromberg), urge-surfing, unwrapping the urge, bridging the cognitive-behavioral “horizontal” plane of human experience with the analytic exploratory deep experiential “vertical” plane, considering more effective alternative ways to care for oneself, developing Ideal Substance Use Plans and working the new plans into one’s life.
Finally, Andrew did a demonstration interview with one on the participants who was interested in exploring her ambivalence about starting an exercise program, something she knows would be good for her physical and emotional health but finds herself not doing. The exploration led to some important discoveries about fears and negative expectations in the resistance to change then left her feeling more excited and “free” to begin experimenting with the changes she wants to make in her life.
We ended the day with a discussion of participants’ take aways and how they envisioned bringing the work to their offices and communities. There was excitement about staying in touch through our IHRP trainees email list for mutual support, friendship and cross-referring. The global network of harm reduction therapists grew in a beautiful way this weekend! It bodes well for the future of our country and planet that more and more people are embracing harm reduction principles of acceptance, compassion, curiosity, affirmation of difference, collaboration, mutuality and science. I am grateful to be a part of this community and movement and have the opportunity to work with and be inspired by people like these.