Collins / Clifasefi Harm Reduction Treatment for Substance Use

2023
ISBN: 978-1-61334-507-8
Verlag: Hogrefe Publishing
Format: EPUB
Kopierschutz: 6 - ePub Watermark

E-Book, Englisch, 126 Seiten

Reihe: Advances in Psychotherapy - Evidence-Based Practice

Harm reduction approaches are effective, patient-driven alternatives to abstinence-based treatment for people who are not ready, willing, or able to stop using substances. This volume outlines the scientific basis and historical development of these approaches, and reviews why abstinence-based approaches often do not work. The authors then share their expertise about harm reduction treatment (HaRT), an empirically based approach co-developed with community members impacted by substance-related harm – a first of its kind. The reader learns in detail about the pragmatic mindset and compassionate heartset of HaRT and the three treatment components: measurement and tracking of patient-preferred substance-related metrics, harm-reduction goal setting and achievement, and discussion of safer-use strategies. This volume walks practitioners through all components, provides example scripts for use in daily practice, and illustrates the work through case studies and input from community members. Handouts are available for use in daily practice. This is essential reading for clinical psychologists, psychotherapists, and researchers who encounter people who have substance-use problems.

Zielgruppe

Practical, evidence-based guidance on the use of harm reduction approaches in treatment. A compact and authoritative book for professionals in their daily practice.

Autoren/Hrsg.

Collins, Susan E.

Clifasefi, Seema L.

Fachgebiete

• Sozialwissenschaften Psychologie Psychotherapie / Klinische Psychologie Suchttherapie
• Sozialwissenschaften Psychologie Psychotherapie / Klinische Psychologie Psychopathologie
• Medizin | Veterinärmedizin Medizin | Public Health | Pharmazie | Zahnmedizin Medizinische Fachgebiete Psychiatrie, Sozialpsychiatrie, Suchttherapie

Leseproben

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Description
We did not start out as harm reductionists. Seema L. Clifasefi was originally trained, not as a clinician, but as a cognitive and experimental psychologist, designing experiments to manipulate participants’ memories and experiences. These studies were undergirded by researcher-driven theories about others’ realities, testing the effects of alcohol and alcohol placebos on cognitive and perceptual processes, such as eyewitness memory, inattentional blindness, and false memories. Susan E. Collins, with a recovery history of her own and the intergenerational experience of substance use disorder (SUD), spent time in the 12-step community, diligently learned the pantheon of treatments that encourage people to change in counselor-sanctioned ways, and stood in bathrooms with rubber gloves on, collecting drug toxicology samples, and writing letters to judges. Instead, the harm reduction movement changed us slowly over time, reshaping our practices, our careers, and our lives. We were changed by conversations with our mentors, including G. Alan Marlatt, PhD, Mary Larimer, PhD, Patt Denning, PhD, Jeannie Little, LICSW, and Linda Sobell, PhD, trailblazers in drinking moderation and harm reduction approaches. We were changed by the teachings of community members who had to “bang on the table” to be heard in service settings (Collins et al., 2018), of front-line case managers who told us that harm reduction is the “only thing that works” (Collins, Clifasefi, Dana, et al., 2012), of activists organizing for users’ rights and providing services to their own communities – the Junkiebond, VOCAL, National Harm Reduction Coalition, Chicago Recovery Alliance, People’s Harm Reduction Alliance, Urban Survivor’s Union, among others. These teachings made us deeply reflect on our own frustrations with our belief systems, our institutions, our research, and our clinical practices. We believe this change for us is also happening for many others in our field. Perhaps it reflects a larger sea change that is sweeping across our scientific disciplines, our clinical practices, and the larger collective culture in the US. In substance use and mental health counseling, more narrowly, clinicians, therapists, and counselors are increasingly aware of and learning from grassroots harm reduction movements and from their own clients (Collins, Clifasefi, Andrasik, et al., 2012; Hawk et al., 2017). As harm reduction clinicians, we must support these grassroots efforts without co-opting them, and we need to ask ourselves what we, in our professional identities, can offer to this movement. In response, we wrote this book to describe the evidence-based harm reduction treatment modality we have spent the last decade codeveloping, implementing, and evaluating, together with communities marginalized by substance-related harm. |2|1.1  Terminology and Definitions
As applied to substance use intervention, the umbrella term “harm reduction” refers to a compassionate stance and a set of pragmatic strategies that minimize substance-related harm and enhance QoL for people who use substances, their families, and their communities (Collins et al., 2011). As its name implies, harm reduction breaks with traditional abstinence-based approaches in that its focus is on minimizing harm, and it does not require or even particularly elevate abstinence or use reduction as ultimate goals (Heather, 2006). While we appreciate the contributions of abstinence-based approaches as important and effective recovery pathways for some, we believe harm reduction approaches are necessary additions to the spectrum of care to ensure greater treatment reach, engagement, and effectiveness. 1.1.1  Harm Reduction Heartset Is Foundational As defined above, harm reduction can be described as a set of strategies; however, it is the culturally humble and compassionate spirit or harm reduction heartset with which strategies are applied that is essential. In fact, this heartset should drive the nature of more concrete interventions and the way they are implemented and thereby received by the community. Of course, we are not the first ones to say this. Dave Purchase, the late and great founding director of the North America Syringe Exchange Network (NASEN) and the Tacoma Needle Exchange noted that harm reduction is more “an attitude” than a fixed set of approaches (Marlatt, 1998b, p. 6). Handing out clean syringes constitutes a fairly concrete harm reduction intervention, but Purchase knew the most important part was how he set up his program to center people who use substances, how he handed out syringes with nonjudgment, and how he was in community with love, humility, and compassion in this work. 1.1.2  Harm Reduction Mindset Is Pragmatic Adopting a harm reduction mindset is pragmatic for those of us seeking to work with the entire spectrum of people who use substances. After all, it is substance-related harm that drives the diagnosis of substance use disorder in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5). Pragmatism also drives harm reduction clinicians’ additional focus on QoL. Our research has shown that people who use substances are striving to meet their basic needs and engage in meaningful activities, just as much if not more than changing their substance use (Fentress et al., 2021). This same research has shown that a clinical focus that prioritizes both what people want to leave behind (i.e., substance-related harm) and what they want to move toward (e.g., engaging in meaningful activities, fulfilling basic needs) is associated with positive treatment outcomes (Fentress et al., 2021). |3|1.1.3  Harm Reduction Across Ecological Systems Thinking more systemically (Bronfenbrenner, 1979), harm reduction approaches for substance use may be, and are, applied at various levels. Taking the widest lens, macrosystem-level approaches comprise policy changes (e.g., decriminalizing, legalizing, and regulating substance use; Marlatt & Witkiewitz, 2010) or large-scale provision of high-coverage, combined intervention programs (e.g., comprehensive medication for opioid use disorder [MOUD] plus syringe programs plus antiretroviral therapy; Degenhardt et al., 2010). At the population level, harm reduction can take the form of public health messaging and public service announcements (e.g., the 1983 “friends don’t let friends drive drunk” campaign from the Ad Council). At the community level, harm reduction approaches are often applied within higher-risk communities to reduce risks for that community, as well as the surrounding environment (e.g., low-barrier, non-abstinence-based “Housing First,” needle and syringe programs, safer consumption sites). Finally, harm reduction at the individual level encompasses treatment, counseling, or other one-on-one or group healing approaches (Collins et al., 2011). 1.2  Applying Harm Reduction in Clinical Work
Because clinicians, psychotherapists, and counselors are most active in their professional roles on the individual level of intervention, we focus in this book on an evidence-based psychotherapeutic or counseling treatment protocol that we call harm reduction treatment for substance use disorder (HaRT). However, before we focus on that individual level of harm reduction, we will explore the tenets of the broader harm reduction movement and their relevance for our clinical practice. 1.2.1  Accepting Substance Use Is Here to Stay Substance use has existed for millennia as an essential human behavior (Guerra-Doce, 2015). In our modern societies, one can surmise that most people are engaged in some kind of substance use on a regular basis. (For example, did you have your morning coffee or tea today?) We have thus concluded that it is neither an efficient nor an effective way to spend our time as clinicians trying to eradicate this long-standing human behavior. We are better positioned to do what we can today to help people and their communities reduce substance-related harm. 1.2.2  Acknowledging Reasons for Clients’ Use In contrast to some abstinence-based ideologies (e.g., Alcoholics Anonymous, 2008), we assert that substance use is not “irrational.” While we acknowledge substance-related ...