Compassionate Pragmatism and Integrative Harm Reduction Psychotherapy (IHRP) and Substance Use Treatment Goes Back to the Philippines this August 6th – 10th.
Three years ago I led five days of talks, discussions and training in Manila, Philippines that were organized by an amazing advocacy, education and treatment organization called NoBox Transitions Foundation, Inc. under the leadership of Ma Inez Feria. We met with several hundred clinicians, government officials, current and former drug users, family members, researchers, activists and interested community members. The response was enthusiastic and a process was initiated through a series of meetings following these activities to integrate IHRP into many relevant sectors in the Philippines. Several developments in the country contributed to uncertainty about what could be done and this process was put on hold. Over the last year there has been an increasing sense of need and possibility to create more meaningful and effective treatment for people with problematic drug use that need and want it. This has led to the organization of this upcoming week of activities. I am very excited to return and continue my collaboration with my Philippine friends and colleagues.
In this blog post by Mikli Feria Jorge, one of the team members at Nobox, she shares some quotes from my talks that give a sense of what we did and what we will build on:
Dr. Andrew Tatarsky is a harm reduction psychotherapist and all around extraordinary guy. Rarely do brilliance and kindness reside in the same person, and we’ve learned — and hope to keep on learning! — so much from him on drugs, and on life.
These are quotes from a past Harm Reduction event in NoBox Philippines last August, 2015:
Dr. T: “How can I be of help to you? “
Client: “Nobody ever asked me that question before, they just started telling me what I needed to do.”
“You are where you are for very complex and personal reasons, and we need to respect that.”
“Some of you might think a drug-free society is a good thing. Some might disagree. But the question is: is it realistic? What’s realistic? What’s realistic today?”
“Maybe I don’t want you to be injecting drugs, maybe I don’t want you to be putting your life at risk. But that doesn’t mean that I can’t accept that that’s what you’re doing, with compassion, and then see how I can possibly be helpful to you.”
“What do you love about the drug? How do you benefit from the use? If we can’t talk about the positive benefits of drug use, how can we talk about alternative ways to get those benefits?”
“If people are using drugs in a way that is not problematic, they’re not likely to come to us for help, and it’s likely that they don’t need help. We shouldn’t presume that all drug use is problematic.”
“Risk is a part of life. Human relationships are risky. Intimacy is risky. Getting close to somebody is risky. We cannot live a risk-free life. So we identify the risk, learn about it, and learn how we can reduce that risk.”
“They call addiction a disease, but they treat the person like a bad person. It’s not a true disease model. Like a diabetes doctor kicking his patient out for eating a donut. Do we arrest people who have diabetes when they eat Twinkies?”
“There are many roads to addiction, so it should make sense that there are many roads to recovery.”
“How long it takes is how long it takes.”
“We don’t need to know the destination to begin the journey.”
“How can we make treatment more appealing, engaging, and effective for this large group of people? If the treatment isn’t more appealing than the problem, why would somebody go to treatment?”
“They’re looking for help that will feel helpful.”
“Addictive people are not just having fun; they are frequently managing a great amount of distress. […] We learned that if we give them resources that appeals to them, that fits their needs, they will access them. What did that teach us? Drug users care about themselves, they care about their community, and they have the capacity and skills to access care.”
“Many treatment programs are manualized, one size fits all, go through the phases. No doubt that some people benefit from that, they want it, they need it. [Harm Reduction] doesn’t have a cookbook. The form, the focus, the structure, the timing of the therapy completely emerges from the collaborative process. It’s much harder, and much more scary. We’re making it up with our clients as we go along. This is part of what makes it so radical, but also much more effective.”
“Unwrap the urge: is there a part of me that lives in the urge? An angry part? Scared part? Sexual part? Playful part? Is there something that the urge wants to say? And if I know what this urge wants, is there an alternative choice that I can make that is actually less harmful and more effective?”
“Studies have shown that when we cultivate self-compassion, kindness towards ourselves, it is associated with reduction in anxiety, depression, and substance use. “
“If you only invite one part of you in the room, the part that wants to change, and we don’t invite the part that doesn’t want to change, what happens with that part? If we make an agreement only with the part that wants to change, the part that doesn’t want to change takes over as soon as the person leaves the office.”
“If you can split the ambivalence, get rid of the part of you that doesn’t want to use, now you’re off to the races. ‘Beam me up, Scotty.’ Splitting can grease the addictive flight. Helping patients stay ambivalent, sit with both sides, be connected to both parts of themselves, that’s the goal, really. So that when the part of them that wants to use, wants to engage in potentially destructive behavior, they can stay connected to the other part of them that doesn’t want to die, hurt themselves, lose the money, risk the relationship.”
“Having to commit to abstinence only is like going from no exercise at all to signing up to running a marathon.”
“Tiny little changes can help people begin to feel more empowered, more in charge, more in control, builds a sense of self-efficacy, a sense of hopefulness — these tiny changes can begin the process that leads to quantum change.
“These small steps build, they build optimism, they build on one another.”
“Each time someone makes a positive steps, they’re feeling a little better, they’re feeling more hopeful.”
“Somebody once pointed out: a dead drug user can’t recover. We can start by keeping people alive and safe: You’re worthy of staying alive. I care about you.”