We begin to open up some delicate topics around different treatment approaches such as Abstinence, versus newer principles that are emerging within recovery, called Harm Reduction.

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[Music]
all right
welcome back to another episode of
finding peaks
um brandon burns host uh ceo of peaks
recovery centers joined here today
again uh with my friend here jason
friesma chief clinical officer
and my other friend uh clint nicholson
chief operating officer and a backup
friend
yeah i’ll take it yeah yeah
yeah it’s a heavy hitting episode before
we yeah
dive into these yeah all right feelers
aside
um again welcome back uh so today we are
gonna try
and start a series of episodes
about or the differences between the
grayness
of delivering services that are
abstinence-based as approach but also
starting to inform the idea
and talk about it self-harm
or self-harm excuse me harm reduction
principles
would be the opposite absolutely harm
reduction principles
um and the approach to care and what
that looks like so
within this industry it’s a seemingly
contentious topic
because of all of the grayness that
exists within it
and say when it’s right to
follow the abstinence lens or when it’s
right to
you know say you have a heroin addiction
for example to allow for
time uh a year or two to pass
before starting to entertain maybe what
it would be like to
have a drink um and
uh so we’re gonna start i think from the
ground up as an important aspect of this
to create some
definitions around this and as we go
through this
um because it’s a heavy hitting topic we
would love to
hear questions feedback comments
concerns and anything that we can help
bridge any gaps that might be
experienced on the on the user’s end in
that regard so
going back now i think to 1935 1938
again and there somewhere where
the big book was written that informed
the room’s
individual wellness and abstinence
um jason t us off history how did we get
here
okay uh how did we get here so
historically
um well really back in the 1930s there
was really no treatment for substance
use
there was treatment of the symptoms of
having other medical problems and so
really
people ended up in the hospital for a
month got out went
right back out on the street no
resources of course uh
no real social work uh options no real
uh possibilities and so um from that
history uh developed the the aaa model
and the founding fathers of aaa in
writing the a.a big book
and really um from that came this
this really uh well
the 12 traditions and the 12 steps from
aaa which
really encouraged people to begin to
work a recovery process
and somewhere along the way there uh
came coins
uh i don’t actually know the history of
the coin um to be honest with you and
where they
where that entered into the aaa
process but where um
a metric of measurement was how long
somebody was
free from their well from drinking and
uh and then
down the road even further after that
came from drinking and drug use
and uh and that was uh this token became
um something critically important to
strive for
to gain 30 days of sobriety
uh to gain two months and three months
and six months and
nine months and a year and then 18
months and then every year after that
and celebrating that indicating that i
have not taken any drink and had
or had any drug in this amount of time
and on top of that then our profession
formed
or began to treat uh
substance use kind of following a
similar model
where where the entire goal of substance
use treatment was to get somebody clean
and sober
and a measurement of success with that
would be for the rest of their life
never used another drug
what’s really nice about that model is
it’s really pretty black or white
uh black and white um you’re either
you’re either doing it or you’re not
doing it you’re either putting
heroin alcohol math coke into your body
or you’re not
and if you’re not you’re successful and
if you are you’re not successful and you
have to start over
uh with going down the journey of
getting your coins
and and again it creates the unintended
consequence of that or the
maybe the intended consequences it’s
really clear black and white
if you use again you’re off track
and you have to start over and if you
don’t use you’re being successful
however
that black and white thinking it does
create a little bit
a a thing that weaves its way into the a
culture is
um coming out of uh alcoholism you have
to admit
that you are an alcoholic you have to
say i am an alcoholic and my life is
unmanageable and
um in saying i am an alcoholic it began
it began
what we now know with with the emerging
research on shane it’s a little bit
well shaming to say i am and then
putting anything
after that that that is less than uh
kind to oneself that’s a little bit of a
shame message that
that i am this and so the undependent
consequence i guess of
of kind of having an abstinence-based uh
thinking
or mentality is that well i am this and
i need to
accept that and since i am this it’s
kind of this unchangeable
part of me that i’m an alcoholic today
and in 10 years i’ll be an alcoholic
whether or not i have anything to drink
and again it it it served it has served
and is serving
a huge and important
role in lane coming from nothing this
has been
incredibly useful and helpful in
um gaining sobriety
uh or for people to gain sobriety and
gain
in and work a program that helped them
step out of using um
i would say two out of that tradition
well came the 12 traditions which really
talked about
this aaa thing nobody can profit from it
nobody runs it
the meetings are self-supportive um
and it really built uh
this amazing community of people that
attended a
meetings and and began to get sober um
so it’s to me like when i look at aaa
honestly as an outsider it’s this really
interesting contrast that like
there are there’s this aspect of aaa
that does set up um
this like all or nothing mentality but
on top of that there’s this
amazing community
and culture that that brings people up
and brings people within and
nurtures them through through
early recovery and so i don’t know
there’s just this contrast there and
and i find that to be really interesting
and curious but anyway that’s where
that’s where kind of this where an
abstinence-based model
came from it it came from a grassroots
uh
up origin has a grassroots origin story
and it came from uh people getting
together
in community and holding each other
accountable to stay sober
yeah one of the things that i’ve seen
or that seems to be commonplace within
our industry uh
especially within the past few years
though it’s softening is there
what manifested out of that is that
there is this sort of
moral deficit that’s having and we
haven’t generally coined it as
in the science scientific terms as a
craving state that’s driving those
um addictive behaviors um full stop and
then
so when we think about somebody who’s
using opioids then you have
the um you know the invention and
brought to market suboxone
and sublicate and all of these other
components to it but there was this
immediate rejection from an
abstinence-based culture it felt like
especially
you know coming out of the rooms that oh
well now you’re just using another
substance and it seems to bring back
that sort of shaming component of it
that
you’re different and it’s not the same
and true recovery looks like this but
and this is also where we’re trying to
balance for the viewer here
the transition about the education of
abstinence and then how we get to
something called
a harm reduction model in all of this
and how do we do it
amicably and how do we preserve both
because both are
important in approaches to recovery
journeys
but it’s no longer true in the sense of
things at least for me it feels like
that
one way is the only way and so in sort
of lightly bridging that gap from
what you described brilliantly there and
thank you for the absent side of things
let’s start with
sort of a ground-up definition of what
um
harm reduction looks like well i think
um
yeah great description of
abstinence-based and i
you know when we talk about the 12-step
model and aaa
and the big book and anc and all of
those uh different organizations i think
it’s it really is a story of unintended
consequences because the other
part of um what happened with aaa is it
what it is it’s about
addicts helping addicts right peers
helping peers and
because that was the only treatment for
so long that actually helped to start
shape addiction treatment in general
where addiction treatment became
very very different from mental health
treatment so we’re
uh in to be uh you know
to be perceived as an effective
addiction counselor
uh the it was really about are you an
addict or in recovery or not
versus do you have a degree and have you
been trained in these skills and then
these foundational these mental health
foundational principles
um and so there was a big disparity
between the mental health world
and the addiction treatment world and
now that disparity is definitely being
that
bridge is being closed very very quickly
because i think there’s an awareness now
that we’ve
uh as our understanding of addiction
is more sophisticated and our approaches
to mental health become more
sophisticated
i think that we ended up with something
that looks more like the harm reduction
model which takes into account
this a much more much more of a mental
health approach
to addiction treatment which is this
idea that
you need to meet your client where they
are like so
wherever a person is in their
willingness and ability to change
that is actually where you meet the
person and then that is
where you develop the intervention
strategies to support that person
versus in an abstinence-based model it’s
either you’re going to quit everything
or you’re not going to be a client or
you’re not going to be successful
versus in a in the harm reduction model
it’s much more of a spectrum where
it recognizes that i may be an alcoholic
and i but i may not be ready to quit
drinking however
i want to do something to make this less
impactful on my life to make
less of a negative impact on my life and
so that’s where harm reduction comes in
and it’s uh a good example of the harm
reduction model is
like a needle exchange for iv opiate
users or
methamphetamine users it’s the this idea
that you know these
addicts may not be ready to quit their
substance
at the same time there are ways and
interventions and strategies that we can
support
them we can support families and we can
support most overall the community
by providing them with clean needles by
mitigating the amount of like bacterial
infection and
infectious diseases that spread within
the community
to help eliminate some of the burden on
the on
the medical field and trying to limit
the amount of emergency room visits that
people have to go into so it’s a much
more
it takes a much more broad spectrum
approach and it really does focus on the
idea of
in any form of mental health treatment
you have to start with where the client
is in their readiness and willingness to
change
and if you start above that it’s the
options or opportunity for success are
greatly decreased or diminished
but i think the the word i would put in
there with the needle exchange
is you meet people where they are that’s
like the definition of empathy
right it’s saying i acknowledge that
this is where you are
and you don’t need you know to put the
drugs down to receive
some care and some compassion um
we’ll just we’ll be right here with you
right
and and really it kind of when you were
talking about um the history of
good substance use counselors had to
kind of come from an addiction
background
in their personal life really what
studies have found what’s way more
predictive is the empathy
the capacity for empathy of the
clinician not what their background is
and what what’s behind them and
and i think that’s the link uh that
you’re talking about without harm
reduction absolutely and i think the
irony is you would expect the empathy to
be greater from
to go from addict to addict however what
i think a lot of times happens is
it becomes sympathy right because that
addict who’s in recovery
looks down upon that other person and
recognizes that they’re in pain and that
feels as though they have the path to
give them to to get better
versus actually meeting the client where
they are and saying all right what is
your
we need to create a path together you
know like your path is going to be
different than my path is going to be
different than
this next person’s path in this next
person’s path you know that is the
complication of
uh their of addiction there are no two
addictions that are alike and so there’s
not one equation that’s going to help
uh add it that you can just kind of plug
an addict into and expect a positive
outcome
so we get into this more open gray world
of um different intervention strategies
that are much more geared towards
improving the the overall wellness and
um quality of life of the individual
rather than focusing on these sort of
hard definitions
of what it means to be in recovery or
what it means to be in
sober absolutely and just putting on my
ceo hat here and building a little bit
of tension into the conversation about
this
is about how this industry behaved in
this transition
it out of the gates out of the late 80s
started charging people
an insurance company thousands and
thousands of dollars for treatment
through the aaa model and
so it created this unnecessary
tension between something that was by
itself
peer-driven sophisticated in its
approach
and free from the very beginning and so
it started to make
treatment look kind of silly because
we’re just charging money for something
that is available to anybody and
everybody
with a willingness to change right in
that regard
and so this industry you know when you
when you go to other it’s still
happening today when you go to people’s
websites they’ll say something like
we’re providing a holistic model of care
here
but we’re abstinent space that is not
holistic
i mean full stop and it doesn’t allow
for
an industry that really needs to through
a treatment through the science of
things
to approach the individual and meet them
strictly where they’re at
and it puts this unnecessary pressure i
think on family systems and i think
in my experience of it that’s kind of
put them on their toes like if johnny
comes home and
flinches in the wrong way then it’s all
for nothing and it’s not successful
and it’s created this really unfortunate
black and white language that i think
distances us from the individual who’s
really struggling
um in a really significant way and so
i just wanted to you know sort of bring
that in and
up up front center to honor the
traditions the 12 steps the rooms and
the meetings that this industry did
something really inappropriate
and it missed a great opportunity to
work with
those programs and then also do
something more significant
along the lines of the harm reduction
model in meeting people where they’re at
and then
utilize its strength as an industry to
help bridge those gaps and ensure
different conversations and insights
into
um you know the suffering that comes
about through addiction but i love the
mental health piece as well to it so
um and just curious too in your guys’s
time here within this industry
you know what aspects of working within
addiction treatment
have you seen you know maybe
inconsistencies as an abstinence-based
approach or
you know the thriving of a harm
reduction approach or missteps within
a harm reduction approach as we you know
bridge as an industry
um or anything maybe more to that we can
we know what the industry’s done wrong
here or maybe even the better question
is what do we see it doing right now
well i i think the issue is that
there’s this there are camps right right
like yeah
i mean i’ve done this for so long like
i’ve been asked
hundreds of times if i’m an addict by
clients coming in
and uh i have kind of a lengthy response
i give to that
when i’m feeling a little more curt or
angry i i say this is the only field
where that’s asked like i don’t
my colleagues who do domestic violence
treatment aren’t asked if they
beat their wives like it’s literally the
only spot where it’s asked like
it’s like a litmus test like the only
way you have anything valuable
for me is whether if you have a similar
experience to me
um and to me that is that that model of
like
um well that’s less charitable because i
think what people were asking is like i
need empathy
i need somebody to just sit with me in
this like i need
help and i need hope um
and so once i learned how to deliver
that message like i could
quickly move beyond like whether what my
own personal history is or not so
um that that’s always been a weird
tension for me i don’t know if that
answers your question brandon but
yeah i think i think that’s a a really
interesting point
and um you know there’s
as far as my experience has primari
primarily been in the harm reduction
field actually so i’ve
worked in uh medication assisted
treatment for a really long time and had
a lot of exposure with that and i think
that that’s a whole another topic that
we’ll address at some other point
um but i so the the what i
like about the harm reduction model
personally is that it actually because
it’s a spectrum it includes abstinence
it recognizes that there is a moment in
time where abstinence is
not only important but it’s vital to the
success and the well-being and the
stability of the individual
it just doesn’t insist upon it right
away it doesn’t and say that this is the
only place where we’re going to start
and then this is where we’re going to
end up
it recognizes that the journey is going
to be wild and crazy and they’re going
to be relapses and they’re going to be
complications and they’re going to be
triggers and there
and there’s going to be maybe multiple
treatment episodes in order for somebody
to really grasp what’s going on
but what it does by by having that
openness and that ability
ability to sort of expand and and be
more creative in its navigation
it really does what jason talked about
at the very beginning it decreases that
shame
like it doesn’t reiterate this idea that
if i do these 12 steps
and i’m sober for 90 days and then i
relapse i have failed in my treatment
it doesn’t have that option it realizes
that things life is more complicated
than success and failure
and that failure is an opportunity for
growth
so i really so for me that’s what the
most
exciting aspect of harm reduction is
i i think as far as what the industry or
the harm reduction
field may be missing is their ability to
communicate that message effectively
yeah i just think that it’s been i don’t
know that people really recognize and
understand what harm reduction actually
means and how it
how it impacts and helps people i think
that it a lot of times people just feel
like it’s an excuse to you’re just
allowing people to still use drugs so
you’re not helping them at all
and not really um kind of
changing or adapting people’s lenses to
better understand
exactly what it means to be in recovery
and what it means to be helped
yeah absolutely and i like and i love
the idea too
the concept of you know it having
different starting points i think we
talked about it several hours ago
episodes ago we also talked about being
on a track and everybody kind of doing
their own thing
directionally focused of course but i
think you know when i run into
you know clients as well too when we’re
talking about things like the 12 steps
you know secular folks are going to have
a resistance to especially steps two and
three and finding higher powers and that
sort of thing but i feel like
you know not often talked about but the
bridge in there is the harm reduction
principle allows us to see the steps not
in so much
black and whiteness but as opportunities
for exploration into different things
whether
you know it’s a buddhist mindset or a
buddhist approach to care
um uh the dharma um in that regard and
so
it feels like when we start sort of you
know bringing them together
you know contextually and then and in
practice we’re actually getting a lot
more
out of both flavors and i think that’s a
really exciting piece
and that this industry if it can move
from the camps
and start bringing its tents closer
together and stand outside and start a
fire together we probably get a lot
closer to something meaningful
and help bridge this gap in a really
significant way
and you know for me personally that’s
just something i
i would love to see embraced in this
industry and it’s also something that
um and why this conversation is so
important right now
um and as we go through these next few
episodes so
um you know with that said any any
closing words before we get
a little bit more uh vocal about this
and
insert ourselves and be vulnerable in
the topic well i think the only thing i
wanted to add after what you just said
is
you you mentioned the camps and really
it’s way more of a venn diagram
if we can get out of our camps there’s a
lot more
like especially initially like helping
people get out of their immediate
suffering like
who doesn’t want to do that like there’s
a lot more common ground
there and it’s pretty fertile i would
say yeah
yeah again i think for me as a clinician
it’s exciting to
to see the opportunity for what this
could mean for the field of addiction
and how this really expands our
expands the ability and capacity for us
to be able to help
people not only more effectively but
more of them so
i’m really for me it’s exciting to be
a part of this conversation and it is
yeah moving forward i anticipate the
vulnerability will be um
tough to navigate at times and there may
be some
i don’t know some very hot topics that
get brought up and people might feel
burns but
i just for me i think the the important
thing is that
having this conversation regardless is
all about helping people it’s all about
being able to provide a level of care
and treatment
that helps addicts live better lives
absolutely so
as we move forward um we just want to
recognize there is an absolute
sensitivity to this
uh topic but it’s a sensitivity um
that’s worth exploring and all of this
so if we say things in
you know our future episodes and so
forth that are discomforting or did you
mean to say that
um please ask questions send your
comments and so forth so that
um we can continue to support the
discussion and make clear what we’re
trying to
say about these things moving forward so
thanks again for joining us if you’ve
only joined us
by video in the past um i’m hoping to
get into spotify download our podcast
um you can go to peak’s site as well too
to find
our video and podcast sessions and so
forth there’s just plenty of ways to
listen to us in that regard and so
find us and thanks for being with us and
we’ll see you soon