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Harm Reduction Model—Recovery Readiness Program
The Recovery
Readiness Program of Belle Reve, administered by Kim Marshall, M.S.W., is based
on the Harm Reduction Model—a new psychosocial-educational approach to drug
use that has emerged in response to the AIDS epidemic. The Harm Reduction
Model is an approach to looking at and responding to drug use that does not
require a participant to make a commitment to abstain from their substance
of choice prior to them receiving help. The objective is to provide
services that help persons manage their addictions and health without
abstinence being the only measurement for success. The primary components
of the program consist of 1) individual and group sessions with residents
of Belle Reve to provide appropriate responses to participants’ goals for
recovery; and 2) reaching out to the community to provide information about
HIV/AIDS, the effects of alcohol and drugs, and the risk factors of
substance abuse and HIV/AIDS.
The principal goal of
the in-house Recovery Readiness Program is to provide substance abuse
services to HIV-positive and AIDS-diagnosed individuals and families in a
outpatient setting (versus drug rehabilitation clinic) to minimize the harm
alcohol/drug abuse has on these individuals. Through the Recovery Readiness
Program, Belle Reve is one of the few institutions in New Orleans that will
accept a resident who may still be abusing substances. Although drug use is
not permitted on premises and abstinence is the eventual goal, a resident
who has a “slip” or “relapse” does not have to fear being thrown back onto
the streets. Following the Harm Reduction model, Kim holds as one of her
primary beliefs that a drug user is entitled to services at any point,
whether he is actively using or not. Furthermore, Kim employs the harm
reduction theory to state that interventions and support for active users
lead to behavioral change and result in many users eventually choosing to
abstain from their drug of choice. The harm reduction model suggests that
to change behavior one must first label the behavior as risky, and then
make a commitment to reduce the behavior, and finally take action to
perform the desired change. Belle Reve and Kim patiently employ this
program to encourage residents to keep trying and to note any progress that
is made. Kim states, “If Belle Reve only accepted people who did not abuse
substances, our resident pool would be greatly reduced and so many needy
people would not be helped.”
The outreach portion of
the Recovery Readiness Program at Belle Reve targets adult men and women as
well as teens who are HIV positive and/or at risk of becoming HIV positive.
All participants are alcohol and/or drug users from the New Orleans area
and are predominantly homeless. Kim goes out into the community to combine
both individual and group counseling, with the goal of increasing the
participant’s knowledge and use of safety precautions and to improve their
access to primary medical care. In this outreach portion of the Recovery
Readiness Program, Kim focuses on outside groups and aims to help the
served population learn information such as correct needle cleaning and
condom usage, self-efficacy and self-confidence through communication
skills, social norms to prepare them to reintegrate into society, a
positive feeling about engaging in safer behaviors, and linkage to primary
medical care. Recently, Kim has started bringing a version of her program
to local at-risk school children. Middle and high school students in
Orleans Parish Schools are being educated on HIV/AIDS prevention, addiction
treatment, and local hands-on help options. Prevention through education
targeted at these youths is aimed to prevent spread of HIV/AIDS through the
young African American population, a group that is overwhelmingly affected
by this disease.
All residents entering
Belle Reve must spend a minimum of thirty days in the Recovery Readiness
Program, regardless of whether or not he/she has demonstrated use of
drugs/alcohol in the past. After the thirty-day evaluation period, if Kim
determines that the individual has no substance abuse problems, the
resident may elect to quit the group. All residents are welcome to stay in
the weekly support group, as many issues pertinent to persons with AIDS
(PWAs) are discussed, such as medication education and support from other
PWAs with problems related to living with AIDS. The in-house program includes
group and individual counseling, goal setting, and results monitoring. The
program is funded by Unity for the Homeless, which receives HOPWA (Housing Opportunities for People with AIDS) SPNS
(Special Projects of National Significance) funding, some of which is
applied to substance abuse programs. Belle Reve is contracted by Unity to
perform this service. Recently, additional funding has been applied for
from SAMHSA to enhance and expand the Recovery Readiness and Outreach
programs. For additional information on The Harm Reduction Model see the
following websites:
The Harm Reduction Model: Pragmatic Approaches to Drug Use
from the Area between Intolerance and Neglect
or Beyond Prohibition: Report of the Redfern Legal Centre Drug
Law Reform Project
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