Harm Reduction is a Real Life Account of How it Saved My Client’s Life
- Brainz Magazine
- 3 days ago
- 8 min read
For nearly 14 years, I've helped individuals navigate the complex landscape of addiction in order to achieve recovery. Nicknamed "The Casual Counselor", my approach is unconventional, but undeniably effective.
This story was shared anonymously with the consent of the client’s experience in treatment. Firstly, what exactly is “harm reduction” in the world of addiction treatment? Well, it is exactly what it sounds like: the effort to reduce harm with individuals who have problematic, dangerous, and sometimes fatalistic relationships with drugs and alcohol.
Abstinence, for instance, falls under the umbrella of harm reduction. In fact, it is the “ultimate” form of harm reduction as not using alcohol or harmful substances all but eliminates the likelihood of experiencing negative consequences related to use.
But, and this may shock some readers, there are some clients who come into the office of addiction specialists with a goal to not abstain from use. Rather, their goal is to reshape their relationship with their drug of choice. They want to use more safely, learn to moderate, cut down, and put themselves in a position where they can still enjoy their substance of choice without it ruining their lives.
Allowing clients to retain their autonomy in their treatment is a vital component of harm reduction and for therapy in general. The best ‘gift’ we can offer anyone in this life is their own independence, and, in the therapist’s office, an opportunity to design their own recovery plan based on their own preferences, and not those of the therapist.
It is the healthy way to administer counseling. Their life, their choices, their plans, their outcomes, and, sometimes, the consequences that stem from their choices. Yet, still, the best practices from the helper in the room.
I remember it was on a Saturday afternoon when I received their text:
“Hey, Josh, really sorry to bother you on a Saturday, but I’m throwing up a lot of blood, and I’m not sure what I should do.”
My heart fluttered.
“You need to call an ambulance and get yourself to the ER like right now!”
And so, that’s what they did. They were given an examination by the resident on staff at the emergency department on that fateful weekend, who informed them that they had detected a tiny little cut in the client’s esophagus, and that the blood coming out of them was coming from that abrasion.
It wasn’t a serious injury, but it could certainly become one if, “You don’t stop drinking alcohol for at least a couple of months so this cut can hea”, the doctor informed them,.”If it becomes infected, you could lose your esophagus, get an infection that could potentially get into your bloodstream, damage other vital organ systems, like your heart, your brain, and your lungs. If this thing doesn’t have time to heal properly, this could turn fatal.”
This client had a severe alcohol and cocaine use disorder, and because of that, they spent a lot of time vomiting after days-long binges. Because of all of this throwing up, the esophagus had become inflamed, and that’s where the cut had come into play. The skin had become tender and fragile, and if the puking continued, it was only going to irritate the wound further. Yuck.
At any rate, the doctor’s advice to “stop for at least a couple of months” was enough to scare my client straight. Resistant to the idea of detoxing under medical supervision, per my recommendation to them, they instead went straight to a cannabis dispensary, loaded up on a whole bunch of products, and went through the discomfort of a self-administered cannabis assisted detox for the next 3-4 days.
They made it through without experiencing any seizures, thank goodness, and the cannabis proved to be enough to ease the worst of the discomfort.
Prior to all of this happening, for the better part of a year, this client never missed a single session with me. They were always on my schedule for Monday mornings, at 9 am. The thing is, they got paid on Fridays from their lousy service industry job, and they would proceed to stock up on as much alcohol and cocaine as possible when the direct deposit hit their checking account.
So, by the time they were sitting across from me in the office, they had been up for the better part of 2 or 3 days, loaded on substances, and always severely impaired when 9 am came rolling around. Still, they never, and I mean never, missed a session not once for that entire span.
That said, the sessions were not substantive in terms of the work of conventional therapy. My client could barely communicate. They would try to share, but could not convey cohesive thoughts or form complete sentences, no matter how hard they tried. Essentially, our sessions were spent in relative silence, my client quietly weeping in the chair that was seated next to mine.
They would use up the whole box of tissues sometimes, as they tried to express what it was they were feeling, experiencing, worrying about, or whatever the case may be. But, again, they never missed a single appointment. Not once. I would sit across from them and just “be there”, observing their inebriation and their pain. It was heartbreaking to watch.
When 10am hit, they’d leave and walk back home. They didn’t own a car during this period, and I would not have allowed them to drive on public roads in the state they were in if they had. The whole thing was so confusing to me. Why did they keep showing up? Was this even therapy?
What was happening in these sessions?
It felt like it was just a performance of someone who I truly believed wasn't going to survive much longer. Not at the rate they were using during this period.
However, after the medical scare, they stopped drinking and using coke. They were using cannabis in a regimented way, a dose in the morning, a dose in the afternoon, a dose in the evening and it was helping them get over the worst of the symptoms that they would otherwise be feeling if they had gone the “cold-turkey” route. Which, by the way, is never recommended. At least, not by me.
As this client began to sober up, our sessions started to shift, as they were beginning to become more clear-headed, able to communicate in full sentences, and have coherent conversations with me. A few months into this journey of being without the drink, they said to me one day,
“Josh, I feel like I owe you an apology.”
“An apology?” I replied, “Why do you think you owe me an apology?”
They went on, “For a long time now, I’ve been showing up to our appointments and I couldn’t even talk. I couldn’t even function. I was seeing two of you, my vision was so messed up. I was so fucked up. Awake for days, a head full of whiskey and cocaine, I feel like I wasted your time.”
I responded, “I don’t feel that way, if it’s any comfort.” They replied, “I just needed to know that I wasn’t alone.” Then, they repeated it, and more tears started to fall.
“I understand,” I told them, “And you’re not. I’m always here for you, in whatever condition you’re in or not in, I get it.”
“I just needed to know I wasn’t alone,” they said again, “I just felt so fucking alone.”
They went on to explain in the weeks ahead that this had been a pattern during their drinking career, that it wasn’t uncommon for them to show up to their treater’s office, clearly under the influence and in really rough shape, only to be told by their “helper”, “I’m not going to work with you while you're drunk. Come back when you’re ready to be sober.”
The thing is, they weren’t ready to be sober. At least, not yet. Doing that to a client in the midst of active alcohol or substance use, sending them away from the place that they’re going to, in order to receive help for their disorder, is akin to kicking someone out of a cardiac unit for having a heart attack. That is why they are there. They are struggling with drugs and alcohol. The lack of common sense regarding that concept, I can’t wrap my head around it.
Several treaters had sent them away under those circumstances, and guess who never returned to their office? If I had sent them away, I would have never seen them again. I know that for an absolute fact. They might not have survived their drinking and drug abuse. They might have ended up hurting themselves or someone else. They might have ended up behind bars, or homeless, out trying to survive on the streets. Who knows?
That client taught me a valuable lesson: though we weren’t doing “conventional therapy” during that long period of their constant intoxication, we were still doing work. We were doing the work of “I just needed to know that I wasn’t alone.” I’m grateful I did not show them the door, but, man! Those sessions were difficult to do, just to witness someone in that level of pain, loneliness, and hopelessness.
I felt powerless to help them, but I learned that just by sharing a safe space with them, and meeting them in that difficult place, that they weren’t alone in this battle for better health and hope that they could change. They had at least one person who was going to welcome them in without judgement or condemnation, to watch them silently weep for an hour, and to prepare to do it again & again, for many weeks and months to follow.
“I just needed to know I wasn’t alone”. That’s where the work was happening.
The story has a happy ending: the client from this story is now three years sober from alcohol and cocaine use. They left a toxic job and found a new and better gig that paid them a substantially higher salary. They go to the gym and do yoga several times a week. They’ve mended fences in some of the relationships that were damaged through the worst of their time actively using. They are actually dating again, in I don’t even know how long! 10 years? 15?
They found an apartment with good-enough roommates and moved out from under their family’s roof.
They are achieving independence and better health, and, yes, cannabis is still a part of that equation. But, they don’t abuse it. They use it like a plant medicine, in a very disciplined fashion. They just needed to know that they weren’t alone there for a while, through the worst of it, and I am grateful that I was able to provide that place that felt safe for them, at a time when they were feeling anything but safe.
Harm Reduction. There is a sea-change happening in the field of treating addictive disorders, and this is a powerful example of why, and how, it sometimes works, and qualifies as the best approach and practice to take.
Read more from Joshua Bennett-Johnson
Joshua Bennett-Johnson, Licensed Addictions Therapist
After working for 7 years in an amazing clinic, I launched into private practice in 2018. I love my job. I can say that without reservation. Watching people rebuild their lives is something that is worth more than any dollar amount.
.jpg)