January 2024- Vol. #21, No. 10

Welcome to the new year and the January edition of Tips and Topics.

In SAVVY, guest writer, Kristin Dempsey explains Harm Reduction and her just released book The Harm Reduction Workbook for Addiction.

In SKILLS, Kristin includes some of her favorite exercises that can be used to explore one’s relationship to substances or processes. The exercises are based on the spirit and skills of motivational interviewing.

In SOUL, I experienced what it is like to show up to an island village in Ghana unannounced and unexpected only to be treated like a welcome guest. Even with menu ingredients in hand, can you imagine these “guests” (intruders) expecting you to cook and serve them a meal?

SAVVY

Kristin L. Dempsey, EdD, LMFT, LPCC, is a psychotherapist, counselor educator, and trainer. New Harbinger, NH asked Kristin to write a book on motivational interviewing. After some discussion, they settled on her writing The Harm Reduction Workbook for Addiction. It is a guide to explore one’s relationship to substances or processes via a number of exercises based on the spirit and skills of motivational interviewing. The book was just released this month.

Earlier in the year, Kristin had asked me if I would be willing to check out a PDF galley version of the book and write an endorsement blurb. I was so focused on fun traveling and non-work, that I told Kristin I was staying away from as many projects as possible.

I said however that if she agreed, I would have her guest write for Tips and Topics (TnT) and briefly summarize the main points of the book as a way to get the word out. So here is Kristin Dempsey’s content just edited to fit TnT format.

Tip 1

Harm reduction strategies are not the opposite of abstinence. Harm Reduction strategies include abstinence.

• According to the Harm Reduction Coalition, “Harm Reduction is a set of practical strategies and ideas aimed at reducing the negative consequences of drug use.” It is also a social justice movement “built on a belief in, and respect for, the rights of people who use drugs” (National Harm Reduction Coalition, 2023).
• Harm reduction strategies are not the opposite of abstinence. Increasingly, wellness and recovery are viewed as not a binary of harm reduction vs. abstinence. Harm reduction can be thought of as a collection of strategies that includes abstinence among many other strategies that reduce the potential harms associated with substance use or process behaviors (e.g. gambling, sex, shopping…) For instance, cutting back on drinking can be harm reduction, as is using test strips to check drugs for dangerous additives, such as fentanyl, as is stopping substance use entirely.

Tip 2

Harm reduction (HR) aims to engage and support people who use substances. Motivational Interviewing is “how” you do HR.

If harm reduction is the “what” and “why” of a philosophy aimed to engage and support people who use substances, then motivational interviewing can be seen as the “how”. Motivational Interviewing (MI) is a conversational approach based on practitioner humility and curiosity. MI providers come to meetings without an agenda, but rather an openness regarding what the help seeker needs to explore and build their own recovery.

• Given the way MI enables a provider to collaboratively and non-judgmentally explore a person’s reasons for change, I joined a community of MI providers inspired to create a resource for individuals to explore their substance use using MI principles as part of the exploration process.
• The great joy and challenge of this book was determining how to create exercises that allow the workbook readers to explore how they can step into the MI “spirit” and show themselves self-compassion and acceptance while noticing their strengths and who they can connect with for support. They also practice building their own reflections on their life and ask themselves evocative questions while exploring their values and identifying change talk. If it serves them, they can build their own specific plans for next steps.

SKILLS

In my new book, The Harm Reduction Workbook for Addiction, I have included exercises that can be used to explore one’s relationship to substances or processes via a number of exercises based on the spirit and skills of motivational interviewing. I have included here some of my favorite exercises:

Tip 1

Self Compassion.

Self-compassion is being able to tap into compassion – the desire and ability to help reduce the suffering of others. It is an important component of exploring change. A compassionate stance helps us overcome competing interests and judgments and instead compels us to ask, “what is the next best thing that can be done for the person in front of me right now.” In terms of the workbook, the compassion is directed toward the reader, so one of the first exercises is to explore one’s own self judgments and consider how reframing as learning instead of failure can be useful.

Exercise for self-compassion:

• Describe a situation that you experienced as difficult that you did not handle as well as you might have liked.
• Reflecting back on the situation, how did it make you feel? What did you think about yourself?
• Spend a moment and think about how this situation might have been a step First Attempt in Learning (F.A.I.L.) instead of a failure. That is, what did you learn from this situation that you can now use.
• How does looking at this situation as a F.A.I.L. feel different to you?
• How will you use this information that you learned from your F.A.I.L.?

Here is an example of how this exercise might look: Joe’s FAIL situation was driving a few times when he knew he was over the legal driving limit. Looking back on the situation, he feels really stupid and angry with himself for putting himself, his license, and others at risk. When asked to think of it as a F.A.I.L., he immediately connects to feeling grateful that he did not get into an accident as the result of his drinking. He feels more relief and less shame when he thinks about being grateful that he is thinking about it now; and can maybe avoid any other drinking and driving incidents. He states he wants to make sure he prepares a designated driver if he is going to go out in the future.

Tip 2

Moving from Judging to Noticing.

Moving from Judging to Noticing

• Part of the challenge of exploring one’s own substance use is getting caught up in shame regarding past regrets and behaviors. Shame is often activated by how we think about ourselves; specifically, we often experience more shame when we judge our behaviors. In order to get some space between judging that can activate shame, which can paralyze movement toward recovery, this exercise allows us to practice noticing instead of judging.
• Start with noticing an automatic negative thought you have about an event related to your substance use.
• How does this judgment make you feel about yourself? What additional automatic thoughts spring from this judgment?
• Now shift from judging the thought to describing it without using any judgmental terms. Perhaps you start with the phrase, “I notice that…” or “I see that…”.
• Now spend a moment noticing how describing vs. judging has you thinking about your self? What is the cost of holding onto your judgment? What is the benefit of describing your situation instead of judging it?

Here is another example of how this exercise might work. Cassie finds herself thinking “I should stop smoking so much weed. I am a loser”. She notices that the judgmental thought has her thinking, why should I try? This is hopeless. When asked to describe or notice the situation leading to her experiencing this self-judgment, she stated, “I notice that when I smoke throughout the day, I do not complete all the chores I was hoping to finish.” She further noticed that holding onto the judgmental thought made her feel annoyed with herself and less confident that she could quit. When she thinks about the description, she focuses less on her problematic behavior and more on the goal she wants to achieve completing the chores. Cassie reports such a shift in perspective helps her focus on what she needs to do instead of what she is not doing.

Tip 3

Explore the Continuum between “I quit” and “I don’t quit” a substance.

(a) Imagine that you are on a continuum with quitting a substance and not quitting a substance being on either end of that continuum:

I quit!________________________________________________________I don’t quit!

• Look at the line and just notice all the space in the middle between “I quit” and “I don’t quit”.
• Imagine for a moment, what kind of other behaviors might be between the two statements. Write down as many as you like here. You do not need to be committed to any of these behaviors right now:

Examples:

• I can cut down one drink a day
• I can have one cigarette before 8 AM instead of three cigarettes before 8 AM.

Write your answers here:

(b) Look at your list, you might notice, that you can write down a vast number of options between the two ends. You might even what to step away and return to this list tomorrow and write some more.

When you feel as if you have a listed all the most meaningful options between these two behaviors, circle 1 to 3 options that you might consider as a starting point in your own journey of exploration. You are not committing to anything at this time, you are just thinking about what might be possible for you.

List your options her

1.

2.

3.

As you look at your options, choose one option. Consider for a moment, what might it take for you to be more open or willing to consider exploring this behavior. Write your answer here:

How to Buy the Book:

Where to purchase The Harm Reduction Workbook for Addiction, released on January 2, 2024:

Kristin’s bio:

Kristin L. Dempsey, EdD, LMFT, LPCC, is a psychotherapist, counselor educator, and trainer. For thirty years, she has supported individuals with exploring their own relationships to substances. She is a member of the Motivational Interviewing Network of Trainers (MINT) and has been privileged to provide motivational interviewing (MI) training to thousands of people in behavioral health, primary care, public health, school, corrections, and human services organizations.

Kristin sees clients in her psychotherapy offices in San Francisco and Burlingame, California, and she teaches counseling psychology as core faculty at the Wright Institute’s Counseling Psychology Program and as Lecturing Faculty in the San Francisco State University’s Counseling Program. Kristin is currently serving as board president of the California Association of Licensed Professional Clinical Counselors.

SOUL

I was just in Ghana for two weeks soaking up as much of the culture as one can in a brief time. (I also was soaking up the sweat of hot and humid weather).

One day, we took a canoe ride on the Amudado Mother River in the Volta region of Ghana en route to an island village. As it happened, there was some trouble in the outboard engine so we diverted to a closer island and disembarked. Unannounced and unexpected, we walked into the village on Gabikpo Island.

The Queen Mother of the village greeted us as if this was a well planned tour. We had brought fish, tomatoes, peppers, onions and akple (like corn meal) that was to be cooked on the original destination island. Without missing a beat, the Queen Mother started preparing the meal.

How would your particular culture or subculture handle having complete strangers showing up at your door unannounced and unexpected? Even with menu ingredients in hand, can you imagine these “guests” (intruders) expecting you to cook and serve them a meal?

This is how what happened was explained to me:

• In Ghana, traveling guests are always welcomed, even before a family member would be.
• This is because it is believed that God can try you by taking on the form of a traveler. One never knows who they might be entertaining. Therefore a traveler is treated with the utmost respect and welcoming spirit.

I recognized some cross-cultural religious similarities of beliefs:

• In the Christian tradition – “I was hungry, and you gave me something to eat. I was thirsty, and you gave me something to drink. I was a stranger, and you welcomed me…..The king will answer them, ‘I tell all of you with certainty, since you did it for one of the least important of these brothers of mine, you did it for me.’ (Matthew 25:35, 40 International Standard Version)
• “Don’t forget to show hospitality to strangers, for in doing so, some have entertained angels without knowing it.” (Hebrews 13:2 World English Bible)
• “Prophet Muhammad reminded us of the high status of one who treats his guest well when he said, “…Let the believer in God and the Day of Judgment honor his guest….In Islam, the hospitality relationship is triangular; it consists of host, guest, and God. Hospitality is a right rather than a gift, and the duty to supply it is a duty to God.” (“Treating Guests the Islamic Way“)

You might dismiss these cultural stories as quaint and irrelevant to the real world of the USA and other Western countries. At the start of this contentious Election year, it will be easy to see anyone who votes for the other side as unwelcome strangers. But in this context, I wouldn’t mind challenging my thinking to see:

• Travelers at my door as guests.
• Strangers as possible angels, or sons and daughters of God.

UNTIL NEXT TIME

Thanks for joining us this month. See you in late February.

David