Harm reduction is often a controversial approach to treating addiction and/or minimizing the impacts of alcohol abuse or drug abuse. In her guest post, Kate Bartenhagen, MFT, shares her views on why she now considers harm reduction a viable option in her work as a family therapist to reduce suffering and improve relationships.
Kate Bartenhagen is a Licensed Marriage and Family Therapist who graduated from The Institute of Transpersonal Psychology (currently Sofia University) in Palo Alto, CA (2009). She has worked in the mental health field for 20 years. Areas of interest include mood disorders such as anxiety and depression, substance abuse/recovery issues, women’s issues, and life transitions which may include a search for meaning. She enjoys working with individuals, couples, families, adults and adolescents. Her approach to mental health is a strong belief that people strive towards wellness and have within them the capacity to grow emotionally and spiritually. Ms. Bartenhagen has a bachelor’s degree in English Education (1987) and a Master’s Degree in Counseling and Human Development/Mental Health (1990), both from the University of Iowa. She has also worked with victims and offenders of domestic violence, with families in the court system and foster care system, and in both inpatient and outpatient substance abuse clinics. She can be reached at firstname.lastname@example.org.
Harm Reduction – Why I Consider it a Viable Option by Kate Bartenhagen, MFT
My beliefs about substance abuse/addiction and treatment have evolved. Early impressions were made from observing family members, and the belief that developed was, “People who drink are more fun/funny than people who don’t.” After testing out that theory throughout high school and college, I grew to believe that the “disease of addiction” was a myth – anyone could control his drinking/drug use if he desired. I have a much more complex and rich view of use, abuse, and addiction today.
I battled addiction for 25 years before realizing that I, personally, cannot drink or use drugs in moderation. It was a painful, difficult process that has resulted in my commitment to the mental health and substance abuse fields at their intersection – Dual Diagnosis Treatment. So why, you might ask, would I consider harm reduction when I follow abstinence? The short answer is that my goal as a Marriage and Family Therapist is to reduce suffering and improve relationships. The long answer contains four assumptions.
First, I believe that human beings strive for wellness. I use the term “wellness” to convey that which we all seek (peace, love, security, comfort, belonging, health). Almost no one wishes to suffer and certainly no one sets out to become an alcoholic/addict. Addiction inevitably leads to immense suffering physically, emotionally, psychologically, and spiritually. So why do people use?
This brings me to my second assumption – that people will do whatever it takes to end suffering. Consider someone who is feeling down. If healthy coping skills have been taught (and work) then they will likely be used again (running, dancing, reaching out for support, etc). For many people, however, either their mental health issues are severe and/or they did not learn healthy coping skills. So what happens when a teen with chronic anxiety drinks alcohol and – for the first time in her life – feels a sense of well-being? Calm washes over her. Problems dissolve. She can talk to others. She may use alcohol again. And again.
So my third assertion is that alcohol and other drugs alleviate suffering for some people, particularly for those with an undiagnosed/untreated mental illness. Many drugs of abuse are associated with particular mental health issues. People with ADHD and anxiety often use marijuana. Alcohol is used by stressed out, anxious, or depressed individuals. Opiates initially reduce physical and/or emotional pain and trauma. The addiction is not immediate, but the relief is. Therefore, the pattern of use is established long before the problems of abuse and addiction develop.
My fourth assumption is that we are each on our own individual path. Each path is unique and each person takes his or her own unique journey. Who am I to tell someone how to live his or her life? The truth is, clients have always had the choice. And clients ultimately make their own decision whether we agree or not (as it should be). MFTs are trained to collaborate to reach treatment goals with client participation. Because addiction treatment grew out of Alcoholics Anonymous (AA) and because nothing had been found to work effectively with addicts previously, the AA model of abstinence has become the predominant model. While I believe this approach can be highly effective for some, it misses many. There are as many treatment options as there are individuals. I have met many clients who still have money, jobs, family, and they are not willing to call themselves an addict (and maybe they are not). But they are willing to acknowledge that something is wrong and may be willing to look at alcohol/drug use if abstinence is not presented as the only option.
Harm Reduction – a starting point that realistically addresses the stigma associated with abuse and addiction and the reluctance to label oneself as an “addict.”
So we need compassion for abusers and addicts (and the family members), not judgment. People arrive at my office at all stages of use, abuse, and addiction. I meet the client where they are and consider all possible treatment options. The critical point is that the person is asking for assistance and therefore is appropriate for therapy. Would I suggest an addict try harm reduction? Well, if they do not see themselves as an addict and won’t consider abstinence, then the answer is “Yes.” Reducing harm is preferable to creating an atmosphere in which clients leave because they don’t fit our treatment model OR worse yet, they don’t tell us about drug use and we don’t ask too many questions. I cannot end all suffering, but I can reduce it. That means creating a trusting, open, honest relationship with my client, helping them look honestly at their mental health issues and drug use, and taking whatever steps they are willing to take at this time to reduce their suffering and create more safety and space to continue their journey of self-discovery. SAMHSA recently released a statement regarding Recovery-Oriented Practice:
“One principle we consider important to emphasize throughout the presentations is that the issues of choice and self-determination are central to the notion of recovery—both in terms of recovery from substance use disorders and recovery from mental illnesses. We know there are many pathways to recovery, that recovery is a unique journey for every individual and family, and that the person himself or herself must be the primary driver of this process. The days of unquestioning compliance with expert practitioners are over—if, in fact, that was ever the real situation.”
Harm reduction is a starting point that realistically addresses the stigma associated with abuse and addiction and the reluctance to label oneself as an “addict.” It allows the client and therapist to have an honest, open discussion about the client’s use, and it serves to reduce suffering immediately while treatment progresses.