SOLUTION FOCUSED HARM REDUCTION Working eff ectively with people who misuse substances Dr. Seán Foy Solution Focused Harm Reduction Dr. Seán Foy Solution Focused Harm Reduction Working effectively with people who misuse substances Dr. Seán Foy The Learning Curve Institute Westport, Mayo, Ireland ISBN 978-3-319-72334-1 ISBN 978-3-319-72335-8 (eBook) https://doi.org/10.1007/978-3-319-72335-8 Library of Congress Control Number: 2017963065 © The Editor(s) (if applicable) and The Author(s) 2017 This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. 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Cover illustration: Pattern adapted from an Indian cotton print produced in the 19th century Printed on acid-free paper This Palgrave Macmillan imprint is published by Springer Nature The registered company is Springer International Publishing AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland To Anne and Helen for believing in me A cknowledgements It has been a long journey for me. A very enjoyable one I might add and it has been made easier by the presence of some very special people in my life. I have been blessed to know these people and to call them my friends. Anne, my wife, who has always believed in me and has travelled much of that journey with me. Our three children, Ewan, Calum and Keelan, thanks lads for being cool and keeping your dad grounded. Other people who have assisted me in my journey are my parents for allowing me to make my own way and always being supportive of whatever I decided to do in true Solution Focused style, seeing my strengths when sometimes all I could see were my deficits. My friends: Steve Coyne, for the good word and helpful views on life; Paul Conlon, for being a friend when things got rough; Liam O Loughlin, just for being cool; James Venneear, who assisted in the birth of this book and Clara Franke, who checked each chapter to make sure it all made sense. Also the many clients I have had the privilege to meet while working within addiction, it has literally been a life-changing experience for me. Dr Eoin Coughlan, Dr Shane Butler and Kevin Ducray for their kind support and opinion and Helen Mitchell, much missed and loved. vii c ontents 1 I ntroduction 1 2 Solution Focused Brief Therapy: An Introduction 7 3 Harm Reduction: An Introduction 33 4 Addiction: Theories, Conceptualisations and Current Practice 53 5 Case Studies 79 6 Similarities and Recommendations 105 Appendix 1 111 Appendix 2 115 References 119 Index 129 ix CHAPTER 1 Introduction Abstract In this chapter, we will provide some information on our journey into using SFBT and HR as a modality. The chapter will also set out the aims of the book and there is also a description of each chapters content. Keywords Harm reduction • Solution focused brief therapy • Wet ser- vice • Addiction • National Addiction Centre • National University of Ireland Galway (NUIG) • University of the North of London • College of Staten Island The twin themes of this book—Harm Reduction (HR) and Solution Focused Brief Therapy (SFBT)—are themes which just a few short decades ago would have seemed like deliberate challenges to the prevailing ortho- doxy of substance-misuse therapy: an orthodoxy that considered total abstinence as the optimum if not the sole valid goal of treatment, and that also considered lengthy and intensive therapy to be a necessity where posi- tive outcomes were concerned. Over recent decades, however, due to a greater acceptance of research evidence and a more pragmatic approach by policy makers, both HR and brief therapeutic interventions for substance misusers have gained widespread acceptance. My aim in this book is to look at how HR and brief therapeutic interventions can be successfully combined in working with complex substance-misuse problems in clients who might previously have been considered virtually impossible to man- © The Author(s) 2017 1 S. Foy, Solution Focused Harm Reduction, https://doi.org/10.1007/978-3-319-72335-8_1 2 S. Foy age by health and social services. I intend to do this by drawing on the research and training literature on these themes while also drawing exten- sively on my practice experience in this field. My journey to becoming a clinical psychologist has been one with many interesting diversions along the way: I have worked as a cleaner, a construction worker, a customer service agent with an airline, a bartender and a waiter. I also worked in an amusement park and in a pizza joint. In 2014, I finally achieved the end result of working as a clinical psychologist. When I was 17 years old, I went to live in New York. I am originally from a small West of Ireland town and the journey to New York was made via a short stop working on the buildings in London. This was not because I loved working on the buildings in London but because I did not have the money to travel directly from Ireland to New York. I had failed my final exams in secondary school (high school) and was heading to work abroad as there was, at that time (the 1980s), very little work available in Ireland. Don’t misunderstand me here, I did not leave Ireland reluctantly, I was very happy to be travelling and New York as a destina- tion seemed as exotic as it got. While living in New York I began studying psychology at the College of Staten Island and worked odd jobs to keep everything going. While in New York I became aware of the homeless population and always had a desire to assist in some way. My financial situation at the time meant that I could not finish my degree as a foreign student, so I was forced to leave New York and return to London. I returned, initially to the building trade where I worked for approximately one year. After this I began to work with people who were experiencing homelessness and I found that I really loved it. It was challenging and demanding but it was also amazingly rewarding. I really felt that what I was doing had meaning. It was so practical and it was a job I relished. Throughout my stay in London (approx. ten years) I worked within the homeless population services, and during that time I qualified with an addiction qualification (via the National Addiction Centre) and a degree in social work (University of North London). When I returned to Ireland in 2000, I began working within a substance-misuse team and worked there for over 11 years. During that time I gained qualifications in coun- selling and psychotherapy and a Master’s in Addiction and I finally fin- ished my degree in psychology. In 2011, I was accepted onto the Clinical Psychology programme at NUI Galway and I completed this in 2014. The reason I am explaining this to you, the reader, is not that you will sit INTRODUCTION 3 back and say “gosh isn’t he a great guy”, it’s more that; for me, it’s impor- tant that the reader can place me and where I am coming from. I do not consider myself to be an expert, as I don’t feel as if I know everything, which of course I don’t; but I have a body of experience that I hope to share with you throughout this book. I have always been attracted to people who have a positive, realistic attitude. I often think of the glass half-full/half-empty scenario. If we choose to view the glass as half empty, this will have an impact on how we view life. If we view it as half full, life feels a little better. The reality is that the water is exactly at the 50% mark. How we view it and the way in which we choose to engage with that glass of water can determine our futures. I am not saying that there are not times when things are very difficult, there are. If you have lived a life, you have encountered pain as well as joy. We can focus on the pain or look to the knowledge we learned by experienc- ing it. We can look out for and comment on our ability for dealing with the pain. Ask ourselves, “How did we survive?” This approach to life has always been a positive thing for me. The first time I was introduced to SFBT was when I was studying at the National Addiction Centre in London in the early 1990s. The approach, I thought, was a really nice one but I immediately felt it wouldn’t work with the client group I worked with. At the time I was working with people who were both alcohol dependent and homeless. I had been working with people who were experiencing homelessness for a few years at that stage and had worked in outreach teams and also direct access hostels for the homeless. At the exact moment I discovered SFBT, I was working in a residential setting where people were allowed to consume alcohol on the premises (often referred to as a wet house): essentially an HR residential unit for alcohol-dependent users. My journey into HR work also began in the early 1990s when I first began to work with people who were experiencing homelessness. At first I found the approach almost counter-intuitive, as I felt that the best course of action for people who were addicted to a substance was to just stop. This view point did not take into consideration what the actual people I was working with wanted. I feel I always worked in a respectful way with people and always respected their wishes, including continued active drug use, but somewhere, initially at least, I felt that I should be doing some- thing else in relation to a person’s drug use. However, this changed when I actually began to work with active drug and alcohol users and began to apply the theory and practice of HR to my work. I found the approach to