Table Of ContentSOLUTION
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
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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
