Thread by @MyHarmReduction

I was a harm reduction advocate years before I though critically about our drug laws and policies. (1/n)

My 2nd year MSW internship was at a small outpatient rehab that was 12-step abstinence-only. The vast majority of our clients were mandated- parole, probation, child protective services, social services, drug court, employee assistance programs, DUIs.

Most of my colleagues were in 12-step recovery from substance use disorders or “codependency.” There was one MFT, and a few MSWs. I spent a lot of time during my training reading 12-step literature and going to open meetings to learn about our tx approach/model.

I remember watching the old “chalk talk” videos (I’m sure there are those of you who remember these) where a catholic priest gave presentations about “alcoholism” while writing on a chalkboard. Messages about powerlessness, the 12 steps, etc.

I remember writing a process recording about all I was watching and reading- and that, although I was sure it probably explained some people’s experiences/helped some, it couldn’t explain all people’s problems. My MSW supervisor shut my doubt down.

So I shut up. I was 23 with no personal history of SUD and no family history either. I was the only one questioning it and felt a bit like the outsider for seeming skeptical.

They hired me after I graduated and I stayed on for 10 months before I had to quit and leave. I had two main roles- I was the intake assessment coordinator, using ASAM criteria to determine level of care needs. And I ran the dual recovery aftercare groups.

Part of my role in both capacities was to monitor drug screens (for women) and do the dip stick tests myself. I handled a lot of urine those years. And it created so many awkward and intrusive moments between me and strangers.

I also spent A LOT of time talking to parole and probation officers, CPS workers, social services, and drug court. Our conversations were friendly and often felt like it was “us” vs the untrustworthy client. Sometimes it meant a client got violated.

And we had justification for this approach. I was being socialized into a model that believed that people w SUDs could not be trusted bc of “denial” and that they NEEDED negative consequences and a “bottom” in order to wake up and change. This was okay.

So I started burning out because even though I was told this was the right thing to do, I felt guilty. I felt like my clients had no reason to trust me or to want to build a relationship with me. And it was true.

Another thing was that hardly anyone I did intakes with ever made it to my aftercare groups. And rather than seeing that as a problem, our agency explained it as clients “not being ready” so they were often referred to higher levels of care or sent back to jail.

It got really hard to feel like I was helping anyone. So I resigned and found a great opportunity at a needle exchange in NYC. All I had learned at my previous job was that methadone and needle exchange were enabling.

But my logic in shifting modalities was this- maybe if no one is watching over me and my clients, maybe I could actually develop real therapeutic relationships and try something different with them. But I had no language and I needed a new paradigm for helping.

So I had to seek out supervision and guidance, fortunately I was told about the 2007 Harm Reduction Psychotherapy conference (never happened again, but I won't get into that here) and bought a lot of books and met a lot of people. Connected with Andrew Tatarsky for supervision.

Over the next several years, worked very hard to shift paradigms and internalize what harm reduction principles look like in clinical work. And I loved it. And it worked.

But the recession happened and things got really unstable at work. (I have a thread about my recession fears somewhere where I highlight what happened...) Andrew suggested that I go back to get my PhD so I could write about social work and harm reduction, teach future MSWs...

And it was while I was doing my PhD that I read about the origins of drug criminalization/medicalization here in the US and saw the racist and xenophobic roots of our drug war. It the 1st time that I was interested in ANYTHING policy-related IN MY LIFE. Ha!

It was this reading that opened me up to different policy possibilities in regards to drugs we currently deem 'illicit.' I had honestly never thought about drug policy in a critical manner for all the years of my life leading up to that. And I was a full-fledged harm reductionist

I knew enforcement was racist, and that most laws had a disproportionate impact on communities of color (including my own family members). But I had seriously thought that objective and scientific measures of harm had driven us to criminalize some drugs over others.

And it was during my PhD that I also became very active on twitter (have I told you the story of when/how I started my twitter account?) and got a chance to connect with others who were also exploring alternatives to criminalization.

I do believe that being a harm reductionist helped me become receptive to critiques of drug policy - after all, when examining drug-related harms, policy enforcement harms are right up there at the top. But it was also bc I had grown to be critical of a lot that I'd been taught.

I wasn't born a harm reductionist. I wasn't born a legalization advocate. But the circumstances of many of my life and work experiences really brought me here. And the harm reduction came first. FIN.