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April 19, 2012 Volume 3, Issue 15
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The Weekly Highlights archive is a virtual library of information on recovery. Topics range from peer specialist training and recovery-oriented systems to personal accounts of addiction, mental illness, and paths to wellness. If you've missed a week's publication, check out volumes 1, 2, and 3—more than 70 archived issues are available.

Harm Reduction and Recovery-Oriented Care
by Les Lucas, LMFT
Practitioners who employ harm reduction strategies meet consumers "where they are at" to address substance use. They aim to help people achieve optimum mental health and positive treatment outcomes, while always keeping the consumer's goals in mind.

As with other recovery-oriented services (ROS), there is no universal definition or formula for implementing harm reduction. The fact is, all evidence-based practices are used appropriately if they encourage consumers to make choices that reduce harm and achieve their fundamental objectives.

It's the same in ROS. As we meet consumers where they are at, we find ourselves describing individualized, person-driven wellness and strength-based clinical services that reflect our work with people who have other psychiatric challenges, such as depression, schizophrenia, and obsessive compulsive disorder.

Within this broader person-centered context, the harm reduction model and harm reduction counseling (HRC) include a set of practical strategies that can reduce the negative consequences of drug use. HRC incorporates techniques to help consumers at all stages—from dangerous behavior (harmful use), to safer behavior (managed/controlled use), to non-harmful use or abstinence.

Harm reduction strategies may vary depending on an individual's experience, i.e., whether the person suffers from substance abuse (actively making harmful choices, but still able to control his or her use) or substance dependence (a brain disorder that hinders one's ability to control use, even when he or she wants to). However, it is possible to help people in both groups make better decisions to reduce harm—even without becoming fully abstinent.

As with substance use disorders, interventions account for the level of acuity, severity, and disability. HRC incorporates the following principles, which are central to effective counseling and consistent with good recovery-oriented practices.

HRC strives to minimize harm for people who use alcohol or drugs, rather than ignoring or condemning them.

In ROS, we work to reduce harm while addressing other thinking, feeling, and behavior challenges. We accept—for better or worse—that consumers' psychiatric symptoms are part of our world.

HRC views substance use as a complex, multifaceted phenomenon that encompasses a continuum of behaviors (from use, to abuse, to severe dependence). There is also a continuum of outcomes, from controlled use, to non-harmful use, to total abstinence.

In ROS, we recognize consumers have a continuum of severity as well as a range of successful methods for living with and managing those challenges.

HRC establishes personal goals, such as improving the quality of individual and community life (not necessarily cessation of all drug use), as criteria for successful interventions and policies.

In ROS, we work with consumers to identify personal recovery goals that help build practical interventions and policies.

HRC calls for the welcoming, nonjudgmental, and non-coercive provision of services and resources for people who use substances.

In ROS, we call this "welcoming and unconditional positive regard," which focuses on the consumer as a person and not the label or symptoms. We refrain from judging consumers' lifestyle choices and help them live well in the community.

HRC gives people who use or have used substances a real voice and representation in programs and policies designed to serve them.

In ROS, our policies and procedures require and encourage input from mental health consumers to create programs and policies for their benefit.

HRC recognizes poverty, racism, social isolation, sexism, and other social inequalities affect people's capacity for managing substance use–related harm.

In ROS, we use case management, housing, food stamps, and payee services to assist consumers with food, shelter, and clothing needs. Staff and consumers recognize past trauma, stigma, and racial injustice affect one's ability to handle harmful aspects of thinking, feeling, and behavior challenges.

Les Lucas is a Clinical Supervisor in the Fresno County Department of Behavioral Health, Substance Abuse Division. He can be reached at llucas@co.fresno.ca.us.

Photographs Shatter Stigmas
In her personal and family struggles with mental illness, Wendy McNeil has found solace in photography. She is the co-founder of COTO (Chronicles of the Ordinary), a San Diego-based initiative to capture the lives and talents of those coping with mental disorders like schizophrenia and major depression. The photos feature people in their element, whether it's playing music, creating art, or pursuing more adventurous hobbies, like Nancy Fuller's motorcycle rides through Alpine, California.

"Photography is very meditative to me," said Victoria Maidhof, a lead artist for the project. "So in an attempt to cope, I thought I'd look for other people with mental illness and photograph them."

Health Equity Takes Top Priority
April is National Minority Health Month—a time to raise awareness about health care inequality and address the disparities that affect racial and ethnic minorities.

Despite our Nation's progress over the past 50 years, some populations still have limited access to quality health and preventive care, which can make them more susceptible to illnesses such as diabetes, heart disease, and colon cancer.

The Department of Health and Human Services (HHS) has mobilized a plan to lower health care costs by investing in prevention and supporting care for underserved groups. Today, more than 1.2 million people have secured coverage, regardless of their race or ethnicity.

To learn more about National Minority Health Month and how HHS is working to achieve health equality for all Americans, visit www.minorityhealth.hhs.gov/Actnow.

SAMHSA's Office of Behavioral Health Equity (OBHE) opened in 2011 to promote services and support for diverse populations. Driven by HHS efforts to reduce health disparities and SAMHSA's Eight Strategic Initiatives, OBHE coordinates policies and programs that expand culturally appropriate outreach, cross-cultural partnerships, data collection, and access to quality services. In her newest blog, Office Director Larke Huang, Ph.D., discussed the importance of collaboration. As a priority, OBHE will build partnerships with community members and providers.

Stories From a State Mental Institution
Having suffered through a series of failed suicide attempts, Lucy Winer was committed to Kings Park State Hospital—a psychiatric center outside of New York's Suffolk County. Today—more than 30 years after she left the asylum—Lucy recounts her harrowing experience as a 17-year-old girl in the hospital's violent ward. Her award-winning documentary culminates a decade-long effort to confront her past and expose the prejudice and cruelty patients endured every day. In a compilation of provocative interviews and flashbacks, Kings Park: Stories From an American Mental Institution reveals the facility's tragic past.

Watch the trailer.

The RTP Resource Center Wants to Hear From
Recovery-Oriented Practitioners!
We invite practitioners to submit personal stories that describe how they became involved in
recovery-oriented work and how it has changed the way they practice.
The RTP Resource Center Wants to Hear From You, Too!
We invite you to submit personal stories that describe recovery experiences. To submit stories or other recovery resources, please contact Cheryl Tutt, MSW, at 877.584.8535,
or email recoverytopractice@dsgonline.com. All stories are reviewed by Carrie Nathans, RTP Editor.

We welcome your views, comments, suggestions, and inquiries.
For more information on this topic or any other recovery topic,
please contact the RTP Resource Center at
877.584.8535, or email recoverytopractice@dsgonline.com.


The views, opinions, and content of this Weekly Highlight are those of the authors, and do not necessarily reflect
the views, opinions, or policies of SAMHSA or the U.S. Department of Health and Human Services.