Harm reduction's humanistic origins
The Editor's Series "Remaining Humanistic in a Managed Care World" continues. This article focuses on methods that humanistic practitioners can use to help people who are suffering from addiction in a person-centered way using modern harm reduction philosophies and approaches.
My objective is to continue the conversation about how to be humanistic in a managed-care world, particularly in the quickly changing field of community drug and alcohol treatment. I spent a lot of time at the recent Society for Humanistic Psychology (SHP) Conference letting my eyes wander around the individuals at the presentations and the pages of the program, looking for humanistic people who practiced in a similar context as me. Currently, I am leading a team of clinicians and caseworkers that are focusing on Substance Use Disorder, as defined by the DSM-5. This team is part of a broader Community Mental Health (CMH) organization in Pittsburgh, Pennsylvania, and it works with a population that is suffering more than the average.
I've had a hard time finding anyone in Div. 32 who work in CMH, much less specifically with so-called "addicts." It may be difficult for some to assert that humanistic psychology's non-definitive techniques are focused on a single disorder. There are also humanistic concerns with directing therapy toward a single concept and having a clear aim in mind before beginning work with a client. Others may find it ludicrous that so much time is spent on the symptom rather than the underlying problem. It's also possible that there hasn't been much discussion or research about humanistic approaches to addiction. And it's past time for that to end.
There are headlines about an opioid epidemic sweeping throughout the country almost wherever you look. Overdose deaths have risen dramatically along the Appalachian Mountains from New Hampshire to Tennessee, as well as across the Southwest from Nevada's western tip to New Mexico's Texas border. With the majority of modern addiction treatment methodologies in place for the duration of this newest drug pandemic, as well as many others before it, such as heroin in the 1970s, crack in the 1980s and 1990s, and oxycontin in the 2000s, it's past time for a shift to humanistic ideas.
This transformation is already underway, and it's known as damage reduction.
"Harm reduction is based on a set of practical concepts and compassionate practices that aim to reduce the negative effects of personal drug use and high-risk behaviors." (Marlatt, p. 3; Marlatt, 2011). "Also, harm reductionists believe that treatment should not be based on coercion or confrontation, but rather on the belief that "[it] supports any step in the right direction" (Logan & Marlatt, 2010 p. 2), and that "thus harm reduction approaches embrace the full range of harm-reducing goals including, but not limited to, abstinence." (P. 249) (Tatarsky, 2003). Barry Lessin (2017), who has a private practice in Philadelphia and is the co-founder of Families for Sensible Drug Policy, tells his clients that he believes in five key harm reduction beliefs:
"You're behind the wheel."
"Any change that is for the better is a good thing."
"I meet you where you are right now in your transformation."
"Each person's road to recovery is different."
"Change paths are adaptable."
By removing the requirement of complete abstinence prior to treatment, the harm reduction practitioner may actually meet the individual where they are and offer answers and trials of safer behavior as the person is ready. This strategy is based on the realization that addictive behaviors do not occur in a vacuum. They aren't just the behaviors of a depraved soul or the replies of a sick mind. They are activities that are significant and serve a purpose in a person's life (Denning & Little, 2011). Taking this into consideration allows the practitioner to grasp the person's unique experience while also addressing bigger societal and cultural issues.
Because we're in the heart of a big metropolis, the people my team helps have been through a lot of difficulties and have been through a lot of trauma before they came to us. Our team has decided to dive into the deep, dark waters of harm reduction as a result of this predicament. We have come to accept the "better is better" motto (Anderson, 2011), which includes case management, housing, education, and other services outside of standard treatment.
While not formally labeled, harm reduction has gained traction among policymakers and not only practitioners. Housing First initiatives have helped to significantly reduce the number of people who are homeless as a result of a substance use disorder (Tsemberis, Gulcur & Nakae, 2004). Traditional housing support models required the person to achieve abstinence before being placed in permanent residence, which added stress to the person's life and raised the risk of dangerous, addictive behaviors. Housing First ensures a person's long-term safety before assisting them in obtaining services.
Harm reduction has employed a person-centered approach to redefine how, when, where, and what addiction treatment can be, even if it is not directly tied to Rogerian principles. This reform couldn't come at a better moment, given the rise in inequality, strife, and struggle.