Do Less Harm

When Patt Denning moved to the Bay Area to practice psychology more than three decades ago, substance abuse was treated by public agencies separate from those that handle mental health issues. If someone came into her mental health clinic with a drug or alcohol disorder, Denning was supposed to send the client to AA or a drug treatment program.

“That never made much sense to me,” she says.

During the AIDS epidemic in the 1980s, when she ran a mental health clinic in San Francisco’s Castro neighborhood, Denning noticed that many of her patients began developing substance abuse problems to cope with the trauma of friends dying and, in some cases, the prospect of their own death. She directed them to AA and Narcotics Anonymous meetings, as she was taught. But they kept dropping out.

“They didn’t want to be there. Something was rubbing them the wrong way,” Denning recalls.

So she decided to get a closer look and see for herself, and suddenly her clients weren’t alone in feeling that way.

“As a medical professional, I was appalled. Here they are making people take on this identity of a lifelong addict who lies and cheats and has fundamental character flaws. They consider abstinence the absolute measure of treatment success and frame drug use and sobriety as ‘good’ and ‘bad.'”

Denning’s brief foray into AA’s peer support-group subculture led her to develop an alternative: a clinical model to treat substance abuse based on psychotherapy, cognitive behavioral skills and the right medication. The new treatment plan favored harm reduction over absolute sobriety and integrated clinical care with peer support.

“Instead of imposing a single agenda on them, giving them these all-or-nothing terms, we asked the patient to define their goals,” Denning says.

Though incomplete as a treatment, AA has helped millions of people maintain sobriety and has been a lifeline for people who can’t afford to pay for more comprehensive care. It also offers a critical aspect of recovery: community.

“You need that support from other people,” Brady says. “People who struggle with addiction have a strong sense of isolation and need to learn how to interact with people in a healthy way again. These 12-step groups provide that.”

Decades later, some public agencies are starting to employ an approach similar to Denning’s, combining substance use centers with mental health clinics. In January, Santa Clara County merged its drug and alcohol treatment and mental health offices into a single unit called the Department of Behavioral Health Services.

Dr. Sally Broder, a psychologist assigned by the National Football League to work with 49ers players who get a DUI or a dirty drug test hews to Denning’s philosophy of “do less harm.”

“It’s realistic,” Broder says. “The NFL players I work with, like a lot of people, don’t feel like they have a problem only abstinence can solve. I work with them to come up with a moderation management approach. The important thing is that we’re having conversations about their substance use, open discussions that lead to insight into their mental, and overall, health.”

Over the past decade as head of the county’s Addiction Medicine and Therapy Division, Dr. Mark Stanford has helped the Valley Hospital System roll out what health professionals call “integrated care.”

“There have been tremendous advancements in our understanding of addiction,” Stanford says. “But the science is sometimes at odds with the recovery movement. For example, we have all kinds of medicines now available that help can suppress cravings and help during withdrawal, but there’s a bias in recovery circles against taking any kind of pharmacological aid. They say you can’t be sober if you’re on certain medicines. Obviously, that’s inaccurate.”

Breaking Hate

Society at large seems more open about recovery, with publications dedicated to drugs and sobriety (The Fix) and pop culture addressing every shade of drug addiction in movies like Winter’s Bone, sex addiction (Thanks for Sharing; Shame) or tech addiction (Her). But some recovery stories remain necessarily hidden.

In a warren of cubicles at the county Office of Human Relations, Kate Jones compiles lesson plans for people convicted of hate crimes. Part of her job as coordinator of Network for a Hate-Free Community is to rehabilitate them from racism. Unlike pedophilia or addiction, racism is not a diagnosable medical condition. It’s a state of mind—social conditioning often expressed by aggression.

Most of the people she teaches are young men who don’t understand the cultural context of their crimes. Jones starts from square one, teaching them how their hate and bias developed against the victim’s demographic.

“I do push them to take responsibility for what they’ve done,” Jones says of her class, which usually consists of one-on-one exercises, “but I also know how ignorant I was when I finished school. … So, it’s not about putting them down for not knowing that their actions were racist—how could they know when the system failed them? It’s about lifting them up and giving them the tools to move on in a more enlightened state.”

Jones also invites victims of hate crimes to come and speak to her clients.

“That can be very powerful,” she says. “Because a lot of people don’t realize that the reason we prosecute hate crimes is because it affects an entire community. This really drives home the impact of their actions.”

Jones remains in touch with some of these former students, she says. They’re often deeply ashamed because of the public nature of their crimes and have a tough time finding jobs because their names and crimes often come up in news articles during cursory background checks.

“It’s difficult to empathize with someone who commits these type of acts,” Jones says. “They know that. It’s a hard realization to come to.”

On a national scale, however, there are efforts to make those stories public as an act of redemption. Christian Picciolini, a reformed skinhead who once fronted a white power metal band and reached a celebrated rank in a white supremacist gang in the 1980s, founded a group called Life After Hate. The nonprofit promotes discussions about discrimination.

“I was drawn in by the culture—the look and the music,” Picciolini tells Metro . “I was also looking for a family unit and the skinheads became it. I didn’t remotely come from a broken home, but my parents, who were Italian immigrants, both worked very hard and were away from home often. I grew up wanting them around and replacing them with this group of older skinheads. Before long, I started to adopt the ideology as well. It started to make sense to me and I started to believe the reasoning.”

Picciolini found the strength to change, through a protracted series of realizations that began with the birth of his two sons. Today, he’s the author of Romantic Violence: Memoirs of an American Skinhead , a touring speaker and “peace advocate.” Going public with his past was tough, but he considers it part of his redemption.

“I think that there are two main reasons why people have a hard timing coming out: because they are scared that people will think less of them, and because they don’t have a support system,” he says. “Many times gangs or drugs are their support systems. What I’ve seen is that people only make these types of decisions (hate/addiction) when they don’t have, or can’t envision, another more positive opportunity.”

Raising Voices

In 2005, advocacy group Faces and Voices of Recovery released a “Recovery Bill of Rights,” an 11-point statement that demanded, among other things, that people in treatment be allowed to set their own goals. It demanded that policymakers remove barriers for people in recovery to find housing, jobs and non-discriminatory health care. It also demanded the right to speak freely about recovery to show that these stories are more common than once thought.

“Maybe it’s a generational thing,” says Ha, driving home from Los Altos High School, where he shared his account about living with bipolar disorder to a group of students. “Younger people, we like to talk things out more. We post our status updates or photos on Instagram. We’re reaching out a lot more, and we need that. You can’t deal with this shit alone.”