Editor's Column

The humanistic roots of harm reduction

A continuation of the Editor's Series, “Remaining Humanistic in a Managed Care World.” This focuses on tools that humanistic practitioners can use to assist those suffering from addiction in a person-centered manner using new harm reduction philosophies and techniques.

By Kevin Gallagher, MA

My hope is to continue the discussion on how we remain humanistic in a managed-care world, especially in the rapidly changing environment of community drug and alcohol treatment. During the last Society for Humanistic Psychology (SHP) Conference, I spent a good deal of my time letting my eyes wander around the people at the presentations and the pages of the program, checking for humanistic folks who practiced in a similar setting as myself. Currently, I am supervising a team of clinicians and caseworkers whose focus is on what the DSM-5 now calls Substance Use Disorder. This team is underneath a larger Community Mental Health (CMH) organization in Pittsburgh, Pennsylvania, working with a population of people suffering more than most.

I have found it difficult to find people in Div. 32 who are working in CMH, let alone specifically with so-called “addicts.” For some, it may be difficult to take the very non-definitive practices found in humanistic psychology and claim to focus on one disorder. There are also humanistic issues with pointing therapy towards one idea and having a definitive goal set before starting work with a person. For others, it may seem absurd to spend so much time on the symptom rather than the deeper issue. Then again, it could be that there has been little talk and research about humanistic approaches to addiction. And it's about time that ended.

Everywhere you look, there are headlines about an opioid epidemic that sweeps through multiple parts of the nation. Overdose deaths have skyrocketed along the Appalachian Mountains from New Hampshire to Tennessee and across the Southwest from the western tip of Nevada to New Mexico's border with Texas. With most of modern addiction treatment modalities already in place for the duration of this latest drug epidemic and many epidemics before, such as heroin in the1970s, crack in the ‘80s and ‘90s and oxycontin in the 2000s, it is beyond time for a shift to humanistic ideals.

That shift is already taking place and it's called harm reduction.

“Harm reduction is founded on a set of pragmatic principles and compassionate strategies designed to minimize the harmful consequences of personal drug use and high-risk behaviors” (Marlatt, 2011, p. 3). “Additionally, harm reductionists believe that treatment should not be based on coercion and confrontation, and instead believe ‘[it] supports any step in the right direction' (Logan & Marlatt, 2010 p. 2) and ‘thus harm reduction approaches embrace the full range of harm-reducing goals including, but not limited to, abstinence'” (Tatarsky, 2003, p. 249). Barry Lessin (2017), who runs a private practice in Philadelphia and is the co-founder of Families for Sensible Drug Policy, maintains five core beliefs of harm reduction that he tells his clients:

  • “You're in the driver's seat.”
  • “Any positive change is good.”
  • “I meet you where you are now in the process of change.”
  • “Paths to getting well are unique.”
  • “Paths of change are flexible.”

By removing the directive of total and perfect abstinence prior to treatment, the practitioner of harm reduction can truly meet the person where they're at and come up with solutions and trials of safer behavior as the person is ready. This approach is built from an understanding that addictive behaviors are not done in a vacuum. They are not simply the actions of an immoral soul nor the responses of a diseased brain. They are meaningful activities that have a purpose in the person's life (Denning & Little, 2011). Taking that into account allows the practitioner to understand the individual experience the person is having while considering larger social and cultural forces.

Because we are located centrally in a large city, the persons my team serves come from significantly troubled and traumatic situations before finding themselves in our care. This situation has backed our team into diving into the deep, dark waters of harm reduction. Instead of pushing or mandating perfect abstinence and only focusing on one aspect of a person's life, we have grown to accept the “better is better” mantra (Anderson, 2011), while including access to case management, housing, education and other services outside of traditional treatment.

Harm reduction, while not specifically named, has caught on with advocates of policy change and not just practitioners. Housing First initiatives have helped to drastically cut homeless rates due to substance use disorder (Tsemberis, Gulcur & Nakae, 2004). Traditional models of housing assistance forced the person to achieve a state of abstinence prior to permanent housing, creating more stress in the person's life, which could lead to increased unsafe, addictive behaviors. Housing First gets the person to permanent safety and then helps the person access services.

While not explicitly linked to Rogerian philosophies, Harm reduction has used a person-centered approach to transform how, when, where and what addiction treatment can be. With the increases in inequality, conflict and struggle, this change couldn't come at a better time.

Additional harm reduction resources can be found at :

References

Anderson, K. (2010). How to change your drinking: A harm reduction guide to alcohol. HAMS Harm Reduction Network.

Denning, P., & Little, J. (2011).  Practicing harm reduction psychotherapy: An alternative approach to addictions. New York: Guilford Press.

Lessin, B. (2017). Barrylessin.com: My Therapy Approaches. Retrieved from: https://www.barrylessin.com/content/harm-reduction-approach-therapy.

Logan, D.E., & Marlatt, G.A. (2010). Harm reduction therapy: A practice-friendly review of research. Journal of Clinical Psychology66, 201-214.

Marlatt, G.A., Larimer, M.E., & Witkiewitz, K. (Eds.). (2011). Harm reduction: Pragmatic strategies for managing high-risk behaviors. New York: Guilford Press.

Tatarsky, A. (2003). Harm reduction psychotherapy: Extending the reach of traditional substance use treatment. Journal of Substance Abuse Treatment25, 249-256.

Tsemberis, S., Gulcur, L., & Nakae, M. (2004). Housing first, consumer choice, and harm reduction for homeless individuals with a dual diagnosis. American Journal of Public Health94, 651-656.