Professional Knows Best

That harm reduction post from a few days ago? DJ Mac blogged on the same article and did a much better job discussing the questions involved, particularly around client preferences, expectations and professional pessimism.

However, when we, the professionals working with them, have not met significant numbers of recovering people, when we have not been to mutual aid meetings to get educated and when we have been telling clients again and again that coming off methadone is too dangerous, then we do have to hold ourselves to account about our failure to be fully informed. How on earth would we be able to give an honest picture to our clients? I saw a tweet today that simply said, “If people don’t know others in recovery then they associate addiction only with the negative.” That may be as true for professionals as it is for those suffering with substance dependence.

Read the whole thing here.

Here are a couple of relevant passages from old posts of mine.

First, on recovery-oriented harm reduction:

I’ve been thinking about a model of recovery-oriented harm reduction that would address the historic failings of abstinence-oriented and harm reduction services. The idea is that it would provide recovery (for addicts only) as an organizing and unifying construct for treatment and harm reduction services. Admittedly, these judgments of the historic failings are my own and represent the perspective of a Midwestern U.S. recovery-oriented provider:

• an emphasis on client choice–no coercion
• all drug use is not addiction
• addiction is an illness characterized by loss of control
• for those with addiction, full recovery is the ideal outcome
• the concept of recovery is inclusive — can include partial, serial, etc.
• recovery is possible for any addict
• all services should communicate hope for recovery–recognizing that hope-based interventions are essential for enhancing motivation to recover
• incremental and radical change should be supported and affirmed
• while incremental changes are validated and supported, they are not to be treated as an end-point
• such a system would aggressively deal with countertransference–some people may impose their own recovery path on clients, others might enjoy vicarious nonconformity through clients

Next, on ideological challenges to collaboration:

PeaPod . . . suggests that [harm reduction and 12 step oriented treatment] can be complimentary.

I’m more and more convinced that this is true. However, the big question is, what values and beliefs animate the intervention?

Can the harm reduction provider embrace beliefs like:

• for addicts, abstinence (a foundation for full recovery) is the best outcome,
• most addicts are capable of achieving full recovery if they are given the proper treatment and support,
• we workers can’t pick the winners and losers,
• drug use by addicts is a bad thing (a symptom of an illness),
• meeting people where they are at is great, but shouldn’t leave them there—it is the responsibility of all providers to look for opportunities to move the addict toward full recovery.

Can drug-free treatment providers embrace beliefs like:

• gradual improvement is good and something to be affirmed,
• self-determination is important,
• choices are not a threat,
• support of the addict should be unconditional—it should continue whether the addict is using or not,
• dead addicts can’t recover.

Where this gets sticky is establishing priorities in the context of scarce resources.