writer’s note: i write in lower case, it’s my small rebellion. trigger warning: this article discusses cutting, mental health, and drug use.
september is national recovery month, and as a harm reductionist for life and active drug user, that has me thinking a lot about my own relationship to recovery. traditional definitions of recovery still solely focus on complete abstinence from drug use (i’m including alcohol as a drug because it is) as both the indicator of success, and the ultimate goal. harm reduction, however, focuses more broadly on increased overall health, well-being, and quality of life as both the indicators of success, and the ultimate goal. the main difference between recovery based models and harm reduction based models is that harm reduction recognizes and accepts the fact that for many people increased health, well-being, and quality of life may also include continued drug use.
in that way harm reduction challenges what our society typically means by healthy, well, and quality of life by asserting that those things don’t automatically or inherently exclude drug use.
shortly before my 20th birthday i was diagnosed with bipolar disorder rapid cycling 2. a few months earlier the mental health center at my college had coerced me into taking an ssri antidepressant as a condition of staying enrolled as a student instead of being forced into medical leave. the antidepressant triggered a manic episode, resulting in a forced hospitalization when a concerned friend revealed to my therapist that i was cutting myself and smoking a lot of weed. i explained that i was in fact not suicidal but was experiencing racing thoughts, anxiety, and insomnia. smoking weed and cutting were coping strategies i had used since i was a teenager to slow the racing, and release the restless anxiety in my body enough to be able to sleep. however, i was still forcibly taken to the hospital by campus police, held on suicide watch against my will for 72 hours, and then forced to attend an outpatient recovery program as a condition of returning to campus.
despite all of that, i continued to smoke weed and sometimes would still cut because for me those were both very effective ways to positively shift my mood, relieve the irritability and anxiety i felt, quiet my over-active brain, and help me sleep. however, medical marijuana didn’t exist yet, and both drugs and cutting behaviors were still very misunderstood and seen as inherently unhealthy, self-destructive, problematic, symptomatic, and dangerous by most mental health practitioners. leaving me at very real risk of criminalization and incarceration, and/or another forced hospitalization for using coping strategies that, despite possible risks, actually worked for me.
about 2 years after i moved to oakland, i experienced another intense mental health crisis. i began having extreme post traumatic stress disorder (ptsd) symptoms, probably triggered when i started consciously recognizing and naming the emotional and physical violence i experienced in my family as a child as abusive. i came out of denial and immediately lost my mind because i couldn’t process or hold the weight of the knowing. like…writing poetry on my bedroom wall in my own blood kind of lost my mind. i really went in. and the strategies i usually relied on, including smoking weed and cutting, were not able to completely pull me out of that dark place like they had previously done. so with the gentle and firm encouragement of a friend i found a therapist through a community-based sliding scale program, and started going in to see her once a week.
our first session was pretty typical with her asking lots of questions about my history, what kinds of things i was struggling with, and what i hoped to get from working with her. so i told her all about my battles with irritability, anxiety, racing and intrusive thoughts, and about how i had previously managed by using multiple coping strategies including smoking weed and cutting. i also explained that smoking weed helped reduce the cutting, and that i’d done a lot of research and experimentation to figure out which strains were best for anxiety, irritability, and racing thoughts versus depression. i very clearly identified cutting as the issue that i wanted to focus on because i recognized that it was scary for people in my life, and potentially dangerous if i accidentally cut too deep.
i was ready for a different way.
i came into our second session excited to get to work. i sat down, and immediately she handed me a list of rehab programs and drug treatment facilities. she then spent the next 50 minutes explaining to me that the primary and most immediate issue to address was my “drug addiction”. and went on to add that once i was clean for 6 months we could look at psychiatric meds to control the anxiety, etc. that i was “self-medicating with marijuana”. fifty minutes of this bullshit that i then had to pay her for out of my own pocket, i don’t care if it was a low-cost sliding scale. so i silently prayed for the strength not to punch her in the face with the rehab list, and patiently explained again that smoking weed was actually helpful, and that in fact the cutting might actually be a more serious concern given the very real danger. let alone the anxiety, racing and intrusive thoughts, etc that i was experiencing.
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our third and final session ended about 20 minutes in after i cussed her the fuck out, and stormed out of the office. she had prepared yet another list of drug treatment facilities, and then told me that she had talked about “my addiction” with her supervisor (without my permission by the way). that experience confirmed for me once again the risks of openly admitting to drug use, especially inside of mental health systems/institutions that view drug use as inherently negative, and problematic. even if that drug use is helping to keep you alive. it also left me without professional support in a time of extreme crisis, and resistant to seeking out help from anyone else. the ironic thing is that the majority of rehab and drug treatment centers on her list would not have actually accepted me because of the cutting and other ptsd symptoms i was experiencing. staff are typically not trained to deal with mental health issues or trauma.
our society mostly views drug use as THE problem instead of as a symptom and impact of trauma. however, if trauma is not addressed in some way and/or is ongoing, our central nervous systems can become overwhelmed and unable to self-regulate properly. it’s like the nervous system gets stuck on and becomes hyperactive, always alert and scanning for danger whether a real threat exists or not. when the central nervous system is over-active in this way we can experience anxiety, panic, anger, depression, intrusive thoughts, flashbacks, body memories, and other symptoms of post traumatic stress disorder. psychoactive drugs directly affect the central nervous system and can help it to relax. that relaxation and settling can then shift a person’s mood, increase pleasure, and decrease physical and emotional pain. therefore we must recognize that drug use is in fact a creative, intelligent, adaptive, and effective coping strategy because it can re-regulate the central nervous system after trauma, and relieve ptsd symptoms.
understanding and accepting that reality allows for more accurate assessments of actual harm/risk, increased compassion and respect for trauma survivors and the ways we survive and cope, and better provision of services for those seeking support. for me that is the ultimate goal.
traditional recovery was not the way for me, however, it is the way for some. and i completely respect that. this is not a piece about bashing traditional recovery or those that have chosen that strategy. it’s a piece about the need for multiple strategies, multiple ways, and multiple goals in mental health and addiction services. and it’s a piece about the complexities of drug use and a “just say no” culture, in a world filled with constant violence and trauma.
coming to harm reduction gave me concrete tools to make more holistic assessments that reflect all of who i am, and create strategies that work for me and my unique set of needs, experiences, circumstances, contexts, and goals. harm reduction also made me take responsibility for my own choices, and be accountable for my own health, well-being, and quality of life and what those things mean and look like to me. and lastly, maybe most importantly, harm reduction reminds me that i am worthy of support, respect, compassion, dignity, health, and being treated well no matter what choices i make around my drug use.
Want more info on harm reduction? Check out www.hri.global
***[Feature Image: A dark skin individual sits outdoors in a field of flowers dressed in a grey hoodie and glasses. They are looking out into the sky. Source: Pexels.com]