MSC’s Belief in Harm Reduction
This week I’m continuing our series on the Men’s Shelter of Charlotte’s (MSC) fundamental beliefs. If you’re joining this blog for the first time I’d encourage to go back and read entries from the last three weeks to learn more about what, as an agency, MSC believes and how those beliefs are put into practice. As promised, this week I’ll discuss MSC’s approach to substance addiction.
One of the issues emergency shelters wrestle with is how best to help people experiencing homelessness who also have an addiction to drugs or alcohol. The first priority should be to keep people safe, which is why the Men’s Shelter of Charlotte (MSC) does not deny admission to our shelters if someone is under the influence. Actually, we want them to come to our shelters so they are off the streets and pose no danger to themselves or others. However, as an emergency shelter we must also recognize that addiction recovery is a journey and will not be accomplished during a short stay in an emergency shelter. Which brings us to MSC’s next fundamental belief: Substance addiction recovery is a life-long process and best supported through a harm reduction approach.
Before going any further, I must explain the difference between the two recovery approaches: abstinence and harm reduction. Abstinence is the immediate and total avoidance of that which is harmful to you, in this case drugs and/or alcohol. Harm reduction, on the other hand, attempts to get someone to begin lessening the use of that which is harmful, again in our case drugs and/or alcohol. I’m oversimplifying these definitions to some extent in order to make these terms easy to grasp.
MSC recognizes that for most of the men we serve who are also battling addiction, asking them to stop their use immediately and completely as a condition of entering our emergency shelters is unrealistic. When the urge to use becomes overwhelming, too often they will choose the streets if their only option is to remain clean and sober at all times. We also understand that most of the men we serve will move out of the shelter into housing in the same neighborhoods from which they came, neighborhoods where drugs and alcohol can be prevalent. So, if MSC wants to help men come in off the streets to a safe environment and then help them move out of the shelter into more appropriate housing, how do we address addiction?
MSC does not condone the use of illegal drugs or the abuse of alcohol. For men with an addiction we want to provide them access to support that will help them approach their recovery for the long term. Through our partnership with Mecklenburg County, men have access to substance addiction outpatient treatment while staying in our shelters. They also have access to AA and NA support groups and we can help them get into more appropriate residential recovery programs if that’s what they need and want to do. Knowing their recovery is a life-long process and knowing that most of our men don’t have the means to escape the neighborhoods where temptation is always a struggle, we want our men to gain practical coping skills so they can continue their recovery when they move out of the safety of the shelter.
Harm reduction is also a tool to engage people to accept help. Trying to reason or negotiate with an alcoholic or drug addict while they are under the influence is fruitless and can backfire. Trust is fragile and easily eroded when people feel like they’re being lectured to or scolded in a moment of vulnerability or embarrassment. Harm reduction helps build trust by meeting someone where they are at in the moment and then building a relationship that hopefully opens the addict’s heart and mind to accepting treatment.
Let me give you a fictional, though all too often real, example. Let’s say John is experiencing homelessness and has battled both alcoholism and drug addiction for the past 15 years. John’s used to drinking a fifth of liquor a day and when he can’t afford or access alcohol he’s known to use illicit streets drugs as a substitute. Too often John sleeps on the street because of his impairment. At MSC, the first thing we’re going to do is invite John to come to the shelter regardless of his impairment (our staff will triage his condition to determine if he’s safe to sleep in the shelter or needs detox or emergency medical care first but then can come immediately back to the shelter). We’ll get to know John and his barriers and, as trust is built, ask John about his desire to get clean and start recovery. If John refuses to engage in conversation about his addiction, we won’t push the issue, instead continuing to assist John which will also build deeper trust. We’ll also begin to plant the seeds of harm reduction, maybe suggesting that John consider a plan where he drinks only every other day or he avoids illicit drugs when he cannot get alcohol. The point is, we want John to take steps to lessen the harm he is doing to himself while also beginning to open up to treatment options and hopefully a commitment to life-long recovery.
We also have to be practical and acknowledge that for many people relapse will be a part of their recovery. It’s unfortunate and sad when relapse occurs but it’s common and should not be viewed as failure – it’s part of a learning process. In fact, an MSC staff member teaches relapse prevention classes in our shelters to help men who know they are prone to relapse. Some folks are able to walk away from drugs and alcohol and never look back. Most, however, struggle mightily with temptation and, as a result, experience relapse. Harm reduction doesn’t encourage or condone relapse. It also doesn’t condemn those who relapse. Harm reduction encourages someone to continue their journey of lessening the harm they are doing to themselves with the ultimate goal of abstinence from their addictive behavior(s).
By the way, harm reduction doesn’t apply only to drug and alcohol addiction. It’s just as applicable to other areas where we want to improve our lives but find doing so very difficult. Almost a year ago I was consuming six to eight Diet Mountain Dews each day. Not healthy! While at my doctor’s office for my annual physical, I asked my doctor how I could go about quitting. I had tried “cold turkey” before only to have debilitating headaches from the caffeine withdrawal. My doctor suggested I chart a weekly reduction path. Every week or two I would cut back my consumption by one soda per day until I was weaned off of it entirely. It struck me as a drove home that he had suggested a harm reduction approach to my destructive behavior! Within six weeks or so I had eliminated all sodas from my diet and have not had one in almost a year now. In no way am I trying to compare my soda issue with the seriousness of a drug or alcohol addiction. I’m only trying to highlight how, for many people, a harm reduction approach offers a doable, less haunting path to overcoming harmful behavior.
Addiction is a destructive disease and an issue we take very seriously at the Men’s Shelter of Charlotte. We want men experiencing homelessness to find the support they need to be successful. Because shelter is more appropriate than being on the streets, we want men to come to us, no matter their barriers. Meeting men where they are at is the critical first step towards helping them regain control in their lives and then chart a productive path for their future. Harm reduction is an effective approach for emergency shelters to employ with people struggling from addiction.
 To learn more about harm reduction and homelessness visit the online Homelessness Resource Center provided by the Substance Abuse and Mental Health Services Administration at http://homeless.samhsa.gov/.
Next week I’ll conclude this series with a look at MSC’s focus on ending homelessness through our equation for success.