Some Thoughts on Harm Reduction

by William Skink

A few posts back Steve W. linked to this Guardian piece about a shelter that gives wine to alcoholics, something the piece acknowledges in the subheading sounds crazy. I read it nodding my head. Here’s a snip:

Dorothy Young, the Oaks’ activities coordinator – a stocky, always-smiling middle-aged woman who is part cheerleader, part event planner, part warden, part bartender – stood behind the counter at a tap that dispenses cold white wine. She poured a measured amount of wine into each cup: maximum seven ounces at 7.30am for the first pour of the day, and five ounces each hour after that. Last call is 9.30pm.

The pour is calculated for each resident to be just enough to stave off the shakes and sweats of detox, which for alcohol is particularly unpleasant – seizures from alcohol deprivation can be fatal. The pour is strictly regulated: Young cuts off anyone who comes in intoxicated. They won’t be given another drink until they sober up.

At the Pov’s old location in downtown Missoula, I used to work 4 ten-hour shifts that started at 5am. I remember one day when I arrived, the EMTs had just finished up assessing a Native client who is probably Missoula’s most “frequent flier” of emergency services. The client had refused transport to the ER, so the ambulance left him shaking very badly in the alley, propped up against a tree near the shelter’s alleyway entrance.

I approached him and asked him what he was going to do, since I knew he had to wait until 8am to buy alcohol. He could barely speak he was shaking so badly. Another client sitting on the side porch was listening to our conversation. He spoke up to get my attention. He said he didn’t want to get in trouble, but he did have a beer in his backpack. I understood what he was offering.

This is the terrible grey area our staff had to navigate as we tried to mitigate the addition we were in the midst of while trying to maintain as much order as possible with our plethora of rules. Technically the client that admitted to possessing alcohol should have lost services for 24 hours, but that wasn’t what happened. Instead I told the shaking client that I was going to go inside and when I was inside someone was going to give him a beer. I told the shaking client that if he went off property to consume the beer, he could then come back and get some sleep in our day room. That is what happened.

But that was at our old location, when we were experimenting with being flexible regarding zero tolerance. For a few years we even established a weather policy that allowed us to sleep people under the influence of alcohol at our old location, but after trying that out it was clear we were putting other clients sobriety at risk, not to mention increasing the danger to clients and staff by trying to be a partial “wet” shelter during the cold Montana winter months.

The new Pov is absolutely zero tolerance now, as it should be. But the consequence of not having some type of shelter and/or housing for people actively using alcohol/drugs means the burden on the ER and jail is that much greater. Those crises are ongoing.

So housing first, as a form of harm reduction, is one approach to begin to address the most core needs of chronically homeless individuals with the added benefit of saving communities that implement this approach lots of money. Missoula is behind other communities already putting infrastructure in place.

Another method I’ve seen be effective is peer support. After reading this Indy piece a few years ago, I’ve continued to hear amazing things about Tahj Kjelland. He works with youth and connects with them through spoken word, teaching “emotional intelligence”.

The Pov has also benefited from utilizing peer volunteers as a part of its outreach efforts. I remember one day in particular being challenged by a Native client I had been having negative run-ins with. We were near the courthouse lawn and the young man made the observation that I didn’t know shit about his life. I was always quick to acknowledge the limits of my experiences (being a privileged white man lacking the experiences of adversity) but on that day the volunteer with me decided to speak up at that moment, asking the Native client where he did time. After the young man answered, the volunteer told him about the places he did time. I could see the surprise, and then the respect, emerge as this client realized that this volunteer did actually have similar experiences, and yet here he was on the other end of those experiences, sober, out of prison, and on the streets trying to help others.

However our community moves forward (or doesn’t) with these issues, the biggest takeaway for me was the critical importance of relationships in the work I did. Despite ignorant proclamations like this, people don’t get better in isolation. Whether it’s peer support, or a mentor, or an advocate, or a counselor, or a fellow alcoholic in AA, without some level of social support I don’t see people getting better.

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About William Skink

I'm a poet and political cynic living and writing in Montana. You can contact me here: willskink at yahoo dot com
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One Response to Some Thoughts on Harm Reduction

  1. JC says:

    “Harm reduction” as a strategy by liberal progressive dems to keep problems out of sight, out of mind is a terrible idea. I put the big push by Obama to accelerate “medically assisted treatment” with suboxone in this category, benefitting the profitability of pharmaceutical giant Reckitt Benckiser above all else with droves of long-term addicted clients to maintain revenues, while offering no long term plan or resources to wean suboxone addicts off the pill.

    On the other hand, harm reduction as a tactic to help keep people alive long enough for them to decide they want to do something different with their lives, coupled with access to needed services, is most definitely a huge positive. I’d put the Ottawa example in this boat.

    But harm reduction, in either case, without a long term plan to provide needed services for addicts and alcoholics moving into recovery is just a band aid on a festering wound. Harm reduction can ease liberal guilt, or it can buy enough time for rock bottom addict to find a new way to live through essential services (if available).

    And yeah, Tahj is a ray of light in the community. He’s got a new album coming out next week, Sol Dream. Good stuff! We booked him for an event this summer. Should be fun!

    Like

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