Top Leaders in Harm Reduction
Dr. Adi Jaffe
Everything you need to know about harm reduction if you didn't know much.
You wouldn’t allow your child to trap themselves in the basement because they’re afraid of the sun, would you? No. You’d probably just tell them to put on some sunblock and wear a hat. Well, good for you! I’d like to personally welcome you to the world of harm reduction.
Harm reduction typically refers to non-judgmental, compassionate, and shame-free policies, programs, or practices seeking to reduce the harmful effects associated with drug use, compulsive behaviors, potentially dangerous activities, and mental health struggles. The focus of harm reduction is meeting people where they ARE, not where you’d like them to be.
Sound familiar? (If not, you should really spend more time reading my other posts.)
In the same vein as handing out condoms to young people (because, let’s face it, they are going to have sex) to keep them free of STDs and unplanned pregnancies, or wearing seatbelts to reduce the occurrence of deadly accidents (because you’re going to drive either way), harm reduction in the world of substance use disorder (SUD) treatment aims to support people who are using drugs by providing less harmful, less risk, and healthier ways to access and use drugs. It’s a recovery approach that treats those struggling with drug use with compassion and dignity.
Why do we need harm reduction? Because America has a big drug problem and shaming or punishing people because of their substance use does NOT help them. When we show compassion we give people in recovery hope, acceptance, and support.
What does harm reduction look like in reality?
Harm reduction aims to provide a safe context for people who struggle to get help. This can be seen in the classic harm reduction form of safe injection sites and needle exchange programs, which keep people (and needles) off the streets and helps those who are using stay safer and those in the community become less exposed to risk as well.
It also means providing alternate methods of SUD treatment like:
Methadone and buprenorphine which greatly reduce withdrawal symptoms for opiate users, remove some of the social issues (crime, violence, etc.) associated with accessing drugs and giving people more regulated drugs than the ones bought off the street (as in not laced with fentanyl or a whole slew of other potential dangerous drugs), thereby reducing overdose risk.
Non-abstinence treatment and support approaches such as Moderation Management, The Sinclair Method for alcohol reduction, or our work at IGNTD.
Marijuana as a replacement substance for opiate users would be another example of reducing the potential harm (overdose and crime) associated with street opiate use or problematic prescription use.
Decriminalizing drug offenses is another form of harm reduction which aims to help people with their struggles on the path to recovery rather than punishing them and locking them up.
Portugal has seen success in their harm reduction policies which involved decriminalizing all drugs in 2001 and as a result, the country has experienced a considerable decrease in overdoses, drug-related crimes, and HIV infection. Remarkable, right! By simply eliminating the punitive approach to substance use and providing people with compassion and support, the drug problem in Portugal has dramatically reduced.
Top Harm Reductionists: How they’ve changed the world
Who are the people driving the harm reductionist approach to drug use and what impact have they had on treatment in America? Let me introduce some of the big players in the field who are revolutionizing the treatment of substance use disorders. I am fortunate to call many my friends, colleagues, or mentors, and their work has, and is, changing the world.
Andrew Tatarsky. Psychologist and founder of New York's Center for Optimal Living, Tatarsky has been dedicated to psychotherapies and SUD treatment for more than three decades. He developed an effective substance abuse treatment program called Integrative Harm Reduction Psychotherapy (IHRP) to address substance use and related behaviors that do not necessarily require abstinence.
Follow him here: @AndrewTatarsk
Stanton Peele. A psychologist who has been a pioneer behind the idea that struggles with substances occur in the context of a range of experiences and a natural process of recovery is required through a harm reduction approach. Peele has been a leader (and a rebel) in the harm reduction and alternative approach to the “addiction war” for decades.
Follow him here: @speele5
Mark Willenbring. Psychiatrist Mark Willenbring is renowned for treating substance use disorders with over 30 years in the field and instigating change in treatment methods in America. He is the founder and CEO of Alltyr, a center for Transforming Treatment for Addiction.
Follow him here: @AddictionDrW
Dee-Dee Stout. California-based Alcohol and Drug Counselor, Dee-Dee Stout specializes in motivational interviewing, harm reduction, and trauma-informed work with people who struggles with substance use.
Follow her here: @1MILover
Maia Szalavitz. Maia is a big name in the field of childhood trauma and SUDs and she co-wrote the famous book, The Boy Who Was Raised as a Dog, with Bruce D. Perry. She is also highly regarded in the addiction field with her new way of thinking about the nature of struggles with drugs or alcohol on a personal and political level and recently wrote the book The Unbroken Brain, which challenges the traditional conceptualization of addiction.
Follow her here: @maiasz
Carl Hart. Dr. Carl Hart is a professor of neuroscience and psychology at Columbia University, where he conducts research on the behavioral and neurological impacts of drugs. As one of the foremost experts on psychoactive substances, he is a highly visible figure in the harm reduction world. Dr. Hart has made appearances on CNN, Fox News, MSNBC, The Joe Rogan Experience, and even testified before congress. He has written extensively on drug use and policy, from debunking harmful myths surrounding drug use to the intersection of systemic racism and the criminalization of drugs. I’ve known Dr. Hart and his work for over a decade now. His deep knowledge base and incredible empathy and personal experience are perfectly married to allow for serious rethinking of the drug-addiction problem and its relevant solutions. Carl has seen what drug use can do, both to society and the brain, and has come up with a completely rational and non-judgmental view of the issue.
Follow him here: @drcarlhart
Patt Denning. At the Center for Harm Reduction Therapy, clinical psychologist Patt Denning is one of those behind the development of Harm Reduction Therapy as well as being a specialist in dual-diagnosis (drug use and mental health disorders) in America since the 1980s. Harm reduction therapy is a client-centered approach to SUDs incorporating psychotherapy so clients can address both the addiction and the underlying causes.
Tom Horvath. One of the founding members of SMART Recovery—a 12-step-alternative self-help group—and the founder of Practical Recovery, Dr. Horvath has been “meeting people where they’re at” for many years. As one of the original group of non-traditional SUD practitioners, Tom’s work has been seminal in spreading the word that there are multiple ways to approach drug and alcohol problems.
Sarah Wakeman. Medical Director at Mass General hospital, Sarah Wakeman is committed to a modern treatment approach to addiction and changing the conversation around opiate dependency. She is also a teacher and consultant on addiction and associated health care costs and resources.
Follow her here: @DrSarahWakeman
Monique Tula. There is, perhaps, no problem more glaring in the recovery field than the lack of resources provided and attention paid to marginalized groups. At IGNTD, we are reminded of this reality every day, working with countless individuals who have spent their lives feeling left out by traditional recovery systems. For anyone who has attended a 12 step meeting, this should come as no surprise. Surveys have consistently demonstrated that AA groups are composed predominantly of white males, leaving others largely ignored by the recovery community. No single person has done more to help uplift and give a voice to these marginalized individuals than Monique Tula. Monique has dedicated her life work towards advocacy for these marginalized groups most impacted by drug use and its adverse effects, including overdose, blood-borne illnesses, and incarceration. As the Executive Director of the Harm Reduction Coalition, she has worked to promote the implementation of harm reduction policies, practices and programs to address the disproportionate impact that drug use has on the most vulnerable communities. Her commitment towards giving a voice to those traditionally ignored by the recovery system and facilitating their engagement in policy making has helped shed light on and address the disproportionate impact of drug use and policy on marginalized groups.
Follow her here: @msmonique_tula
Kim Sue. A recent addition to the harm-reduction fight is 2015 Harvard graduate Kim Sue, whose work in the field of medical anthropology (which includes the justice system, drug policies, and mental health and drug treatment) has shed light on the poor treatment of women who struggle with substances in the prison system and on the streets. She aims to help inform policies for women who transition out of the criminal justice system.
Follow her here: @DrKimSue
Zachary Siegel. Though not a clinician, writer and journalist Zachary Siegel has recently made a name for himself as an important player in progressive drug policy advocacy. Through his writing, he highlights the intersection of public health and the criminal justice system for people who struggle with substance abuse. He is keen to demystify substance “addiction”, especially how it is portrayed in the media.
Follow him here: @ZachWritesStuff
Doesn’t harm reduction send the wrong message to people?
While harm reduction has many benefits for people who struggle with substances and for the greater community, many oppose the idea. After all, doesn’t harm reduction just condone drug use? The fact is that, just as condoms do not condone sexual behavior, but instead protect those who engage in it from unwanted pregnancies and STIs, people are going to use substances, as evidenced by centuries of human history. This is no different to the approach we take on many other social and physical issues we face: To protect our skin from the sun, we don’t hide out in a dungeon, we simply wear some clothing, put on a hat, and slap on some sunscreen. To avoid serious accidents, we don’t avoid cars; we wear seatbelts, or we wear a helmet when riding a bike. (And you HAVE TO read this about pen caps.)
You are already benefiting from harm reduction principles and you didn’t even realize it!
I align myself strongly with the harm reduction approach as I believe in a non-judgmental approach to recovery. I think it is crucial that we meet people where they are at, rather than only helping those who are willing to accept where we want them to be (like committing to lifelong abstinence). That’s why my IGNTD Recovery program does not require complete abstinence from people who seek help as this opens up opportunities for people who want to access treatment but aren’t ready, or don’t have the need or the capacity to quit altogether. For more information about my IGNTD Hero Program, or my book The Abstinence Myth, please follow the links.
If you are interested in learning more about harm reduction, check out this episode of the IGNTD Recovery Podcast with Stanton Peele