The Life-Saving Addiction Treatment Model that No One’s Using
The director of harm reduction services at Valhalla Place talks about his organization's non-judgmental approach to care.
Sep 22, 2015

Words by Holly Harrison

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Unfamiliar with the principles of harm reduction? Don’t blame yourself. Like Valhalla Place‘s Adam Fairbanks says above—it’s not common in Minnesota. It’s not common in many places, actually.

Here’s the gist: harm reduction is a set of strategies and ideas aimed at reducing the negative consequences associated with drug use. The strategies cover the spectrum from safer use to abstinence, all depending on what a person who uses drugs is ready for. By acknowledging that—for better or worse—drug use is part of our world, practitioners of harm reduction work to minimize the harmful effects of drugs rather than ignore or condemn them.

Valhalla Place’s harm reduction services branch looks like this:

  • Once-weekly syringe exchange: trained volunteers provide sterile syringes and collect used syringes, curbing the transmission of HIV, and hepatitis B and C
  • Education, training, and access to Naloxone (AKA Narcan): a harmless and effective medication that reverses an opiate overdose
  • Harm reduction therapy: group and individual mental health services where people who use drugs set goals and pacing together with counselors and clinicians

“When I started my career eleven years ago, I used to bang my head against the wall trying to force harm reduction into the traditional recovery world,” Adam says. “But over time, things started to change. Valhalla started. There have been more books written and more research and evidence to support it. It’s not as lonely anymore because now I’m surrounded by 150 employees who get it.”

Read on for a Q&A with Adam, Director of Harm Reduction Services at Valhalla Place, on what harm reduction looks like, what he’s learned during his career, and how laymen can practice it in their lives.

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How did you find yourself at Valhalla Place?

I met [Karen Greenstein], the owner of Valhalla Place, when I was doing HIV work. A friend of mine who did street-based needle exchange underground contacted me and said, “Hey, I got a donation of syringes. Can I put them in your garage?” And I said, “Absolutely not. But I may have an idea.” So I called Karen and said, “You just opened a new clinic, and I know you probably have space. Can I store these in your clinic?” And she said, “Sure.”

I would pick up the needles once a week and deliver them to my friend on Fridays. After a while I was like, “Man, I really like the concept of having syringe exchange embedded into a treatment facility.” I volunteered once a week on Fridays doing the needle exchange with other volunteers, and it was well-received at the clinic. Shortly after I started doing Narcan training. I did that work for about nine months and then I was offered the job as director of harm reduction services.

My job is to create programming that engages our target audience—people who use drugs, especially opiate users—and gets them to walk in our doors and access our services. We do that by providing things that they want and need, like syringe exchange, which is something that nearly all injection drug users want access to and something we can provide for free. We tell everyone our objective—they’re encouraged to enroll in our services when they’re ready, to transition from using illicit drugs into medication-assisted treatment, so they can become stable and get into recovery.

Tell me about the community that has sprung up around your services.

I think of three communities that have sprung up as a result of our services. One would be the clients that we serve: people who are using opiates and who want to access harm reduction services. That community—people are more independent and alone when they are in active use. So it is a community, but at the same time it isn’t like the same feeling I get when I’m at the overdose vigil, where you have people who have lost loved ones and they’re there to support each other.

Especially if, at least how I understand it, one of the driving forces of addiction is isolation. So it’s hard to build a community of people who feel isolated.

But at the same time, people who use drugs do support each other. They do care about each other. A lot of people don’t understand or forget that these people are friends and they care about each other. Even though there’s drama, it doesn’t mean that when somebody dies that everybody’s not affected. People don’t think about that.

At the [August 31] vigil it was primarily just family members, who I would identify as the second community. At some point I would really like there to be a strong drug user presence there. Because I know that—when we do needle exchange—I know how impacted and upset they are when someone overdoses. And they don’t have enough people to talk to about that. And generally they aren’t connected to any professionals. Which is why Valhalla Place is trying to create other opportunities to get people involved in services, even if they’re not ready to stop using drugs.

In addition to people who use drugs and family members affected by overdose, the third community is professionals. There are a lot of individuals involved in traditional twelve-step programs locally who are supportive and “get” harm reduction. I talk to people all the time who love what we’re doing and think it’s awesome but work at an organization that doesn’t support it. That community is starting to build. [Valhalla] is kind of leading the way, because we’re so out and loud about the fact that we are a harm reduction agency.

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What are some of the common misperceptions around harm reduction that you find yourself debunking a lot, or would really like to see fall away once and for all?

That it’s either abstinence or harm reduction. They’re the same. Abstinence is obviously a major form of harm reduction. If people are abstaining, they’re not using drugs, and if they were using drugs before they’re reducing harm by not using drugs now.

But there’s this tension because harm reduction challenges what they teach people in traditional recovery. What we teach people is that you can use safer. You can reduce harm. You can be empowered to make better decisions. And the traditional model is that you are powerless from these drugs and it’s only going to get worse. So people in the abstinence and traditional recovery model communities look at the work that I do as a threat to what they’re teaching people.

It doesn’t always get worse. It can start to get better. People can start to make better decisions. If people are not informed about the risks of overdose, their odds of overdosing are significantly higher. And traditional recovery-based programs are afraid to provide that education because they look at it as encouraging drug use. The way I look at it is we’re just telling people how dangerous it is, and how to reduce harm.

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Your organization uses a non-judgmental approach. What does that mean in practice?

I would say the biggest part of that is non-punitive. We do not take punitive measures unless it is mandated by a regulating agency like the DEA. Like, if somebody has a positive drug screen then the state expects x, y, and z to happen. We follow those rules, but we don’t go above that. We don’t believe that punishment is a good approach for helping people.

When I’m working with the needle exchange clients and the volunteers, we will educate them about the dangers of drug use, but we let them make their own choices about it. We make sure that we never have that look on our face like, “Oh man—what are you doing?” Y’know what I mean? “Why are you doing this?” We never ask that question.

We accept the fact that drugs are part of our world. We accept the fact that people are, for various reasons, using drugs. And we make sure that we are very empathetic and supportive and let them know that we care. We meet them where they’re at.

If they’re in total chaotic use, and that’s where they wanna be, we give them needles. If they are sick of that lifestyle and they wanna make some changes but not necessarily go to treatment, we will connect them with a therapist. We just let them guide the path that they’re traveling on.
There’s a model in our organization called “It depends.” [Instead of having strict treatment protocols,] we allow our medical providers to use their clinical judgment. We allow our drug counselors to use their expertise the way that they were trained.

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Can you talk about how laymen can apply the non-judgmental approach, instead of sitting people down intervention-style and telling them to shape up or else?

There’s not a single way to address the issue. You can’t just think about harm reduction for an individual [who uses drugs]. You have to also look at harm reduction for a family. For a community. For public safety. There are a lot of different approaches.

It’s not effective to tell people what to do. Sitting them down scares them away. If you wanna be able to help people, they have to be willing to listen to you. That starts with you listening to them, without telling them what’s best for them.

Posted by Holly Harrison on Sep 22, 2015

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