It’s difficult to imagine how the late Nancy Reagan would have reacted if she’d attended Oakland’s Psychedelic Conference this year and heard Maurice Byrd replacing the “no” with “know” in the “Just Say No” anti-drug slogan she touted during her husband’s presidential tenure.
Byrd is a licensed therapist who spends a significant amount of time in unhoused encampments, meeting with people who struggle with chemical dependency. Although Byrd’s work is rooted in a phrase that is phonetically the same as that of the Reagan era, the meaning and approach of his work couldn’t be more different: “Just say ‘know’ to drugs.” Byrd’s approach rejects the societal binaries that deem drugs and the people who use them “bad,” and believes that the only way to help such people is through a “tough love” approach.
“Harm reduction is about treating people with dignity regardless of what they’re going through, and about being trauma-informed,” Byrd says. “Instead of looking at others as problem people, we can see them as people with problems. Instead of asking, ‘What’s wrong with you?’ we can ask, ‘What happened?’ In the black-and-white world we live in, we sometimes say ‘I’m not messing with you anymore ’cause you’re an addict.’ That doesn’t work. We need to live in the gray. A colleague once told me that harm reduction brings color to the gray.”
To put it simply, Byrd says, harm reduction is really about destroying binaries altogether. In other words, it replaces an “either-or” conditional approach with a “both-and” approach rooted in accountability and love. If that sounds complicated and more time-consuming than the “Just say no” approach, it is. In nearly all cases, people who struggle with alcohol or chemical dependency are people with adverse childhood experiences (ACEs), meaning they witnessed or experienced domestic violence, they were separated from one or both parents by circumstance or they experienced a form of emotional neglect.
Sixty-four percent of Americans have at least one of the seven ACE experiences. As the number increases, so does the likelihood of mental and physical health challenges. If a person arrives in adulthood with four ACEs, their likelihood of becoming an alcoholic increases by 700%, and Byrd says their risk of developing a drug dependency rises above that.
“During the Reagan era, there was a model of locking people up and forcing them into prison,” Byrd says. “Studies show that when you allow people to make their own decisions and make their own goals, they are far more successful than when they’re forced.”
In a society best known for 12-step programs such as Narcotics Anonymous, Alcoholics Anonymous and Al-Anon, which are about separating oneself from the dependency of the loved one with the dependency issue, it’s sometimes difficult for folks to conceptualize simultaneously offering love and accountability. Byrd says that although there’s nuance and tension in that, it comes down to offering “boundaried” love.
“I think we should hold people we love accountable for all behaviors, whether or not there’s a dependency issue,” Byrd says. “I had a client who asked me how he should love his uncle who kept stealing his DVD player and his TV. I told him to keep loving him, but to stop letting him in the house or leaving him alone with his electronics.”
Gov. Newsom signed SB 326, the Mental Health Modernization Act, which greenlights it to be on the ballot, as well as AB 531, the Behavioral Health Infrastructure Bond Act. According to his office statement, the reforms of both bills are meant to “refocus billions of dollars in existing funds to prioritize Californians with the deepest needs, living in encampments, or suffering the worst substance use issues.”
Although Byrd hasn’t yet studied the bills, he raises some concerns and contradictions that perhaps aren’t so different from the objections folks raised to Reagan’s one-size-fits-all approach to ending drug use—particularly if involuntary treatment is involved.
“When Newsom announced he had a problem with alcohol [in the early 2000s], Mimi Silbert from the Delancey Street Foundation became his personal counselor, but nobody forced him into treatment,” Byrd says. “This policy isn’t for the lawyers who come to my private practice because they’re using heroin every day before going to work, or the housewives who drink wine. It’s aimed at Black and brown people—people seeking apartments or housing. So we have to ask, what’s the agenda here? I think the agenda is to make it appear that we’re tough on crime and fighting the opioid overdose crisis.”
Yarelix Estrada isn’t a licensed therapist or a medical professional, but she has a job that is as controversial as it is important. She tests drugs for people before they use them, so they can be “in the know” about what does or doesn’t work for them.
“Some of the basic things we teach in harm reduction is, if you’re using drugs, don’t use alone,” Estrada says. “Try a small amount first to see how you respond. Get them tested to make sure you know what you’re having. I don’t do any reporting or paperwork. If I want to have an informal counseling session, I can do that if I want to. We have a ‘no-police policy’ because we’re breaking federal law by doing this work. But it does help people.”
Estrada details an example of testing the drugs of a married dad who was also a teacher. When he began coming to the drug-testing site, he was using to the extent that Estrada considered him passively suicidal: five to 10 times per day, in large quantities. “As I checked his drugs for him, I got curious,” she says. “I asked him what he enjoyed about the drugs he was using. He started talking because nobody had framed the question like that before.”
As the weeks went by, Estrada and the client continued their conversation as she tested his drugs to help him find a safer amount. When Estrada asked about his relationship with his family, he shared that he stayed in his room and tried to avoid interacting with his wife and son as much as possible—in part because he’d already done the 12-step program and was ashamed for them to know he was using again.
“I told him that the connection that he was losing by not talking to his wife or his son is worse than being high,” Estrada says. “We started talking about what it would look like to manage his use so he would be a little less high so that he could be present with his family even while he still used drugs. He shared that nobody had ever told him it was OK to use drugs and be with his family.”
The man, Estrada says, is slowly weaning himself in potency, type, amount and frequency of use—to the point that he managed a five-day road trip with his son without using and has reconnected with his wife. “When he came back and reported that to me, I said, ‘Right on,’” Estrada says. “I reminded him that I’ll keep being here every week. I’ll be here to talk without judgment, whether he’s using drugs or not. I don’t think he would’ve gotten to this place if he kept isolating and using on his own because of shame, or been forced back into a program.”
Roz McMillan works for Alameda County by day and as a therapist focused on providing mental health services to the BIPOC population in her spare time. “I love drugs,” McMillan says. “But they don’t love me.”
In McMillan’s case, a 12-step program helped her transition from being someone who used crack cocaine, heroin and alcohol, to a person who hasn’t used for 35 years. “It’s not about the drugs, but about my relationship to the drugs that caused me harm,” she says. “Those drugs no longer serve me.” McMillan provides micro-dose ketamine-assisted therapy for some clients at Doorway Therapeutics.
“I respect the 12-step program that I went through, but I know it’s not for everybody,” McMillan says. “I don’t believe Western medicine has been able to help me in a society of capitalism, racism, sexism and homophobia. Using some plant-based medicines have been able to help me cope with some of the pressures of life in this body that I’m in.”
McMillan also hasn’t studied the intricacies of the legislation that will appear on the March 2024 ballot as Proposition 1, but she offers her perspective as a social worker working within the system.
“What I recognize from working in a system is the importance of bringing the people to the table anytime you’re providing services for them,” McMillan says. “Anytime people who are politicians try to create services without knowing the experiences of the people they’re providing services to, missteps will be taken. On top of that, if you’re not talking to the service providers who are already on the ground providing the services and understand what is necessary, then people are left to scramble to figure out what to do. That can be a disaster.”