Dan Bigg, Co-founder of the Chicago Recovery Alliance Photo credit: Nigel Brunsdon
Remembering Dan Bigg
I have just been notified of the death of Dan Bigg. He was an amazing and gentle man, but tenacious on the subject of harm reduction. He taught me the phrases, "All lives are worth saving" and "Any positive change." I wouldn't be who I am without his guidance, patience, and friendship. Below is an excerpt from my book, "Coming to Harm Reduction Kicking & Screaming: Looking for Harm Reduction in a 12-Step World"
Please consider a donation to the Chicago Recovery Alliance in Dan's name which you can access here: www.anypositivechange.org. Thank you!
Harm Reduction Oldtimer
I came to harm reduction because I had a personal dissonance between what was being done in addiction treatment and what we knew should be done. Between a family experience with addiction and what happened in the 1980s with the outbreak of HIV infections and AIDS, my dissonance was encouraged. I was in graduate school at the time. HIV came and with it came a motivation to do things differently in addiction treatment and HIV prevention. I got involved with the HIV/AIDS prevention movement from the very beginning, and the end result was a chance - an opening - to do things differently.
With a number of other individuals, I started a support group called HIVIES – HIV Information, Education, and Support - in the late 1980’s. Perry Tilleraas (Editor’s Note: author, Circle of Hope: Our Stories of AIDS, Addiction, and Recovery; HarperCollins, 1990) in Minneapolis was doing something parallel at the time, which they called the Minnesota Recovery Alliance, or MRA. At MRA, they were dealing with traditional recovery issues and HIV transmission through male-to-male sex: in other words gay-friendly recovery issues. Unheard of at that time! By the way, Perry also wrote a little book in the Hazelden-published series of daily meditations for people in recovery called Daily Meditations for All of Us Living with AIDS. He also wrote a book for HIVIES about self-support as most of the people in HIVIES were involved, or had been, in 12-Step recovery groups. Almost all of them also had very negative reactions to those groups.
Basically, HIVIES folks said that when they brought up issues of sexuality in AA, members told them that these were “outside issues.” [Editor’s note: according to AA traditions, members agree to talk about subjects only as they relate to their alcoholism. This is because AA tradition states that “AA has no opinion on outside issues” so that it will not be drawn into controversy. See the AA book Twelve Steps and Twelve Traditions for more.] Their sexuality brought up medical issues and those were outside issues - and AA in 1984, ’85 and ’86 couldn’t see a connection between alcohol and HIV or AIDS. Every week we in HIVIES gathered; it was a powerful experience. I think gathering and sharing like we were doing in HIVIES is also the secret to one’s finding success in 12-Step groups, too, as long as they’re not punitive, manipulative or controlling. The idea of getting together with like-minded people is incredibly powerful, and this is true whether the issue is alcoholism or living well with HIV: it’s that you’re gathered with another warm body and they understand you in ways that most others do not, and you can talk about issues that are generally cloaked in shame and pathology. In HIVIES, we didn’t discriminate, which meant anyone was free to come and share anything about themselves that they felt was important. No one would tell them “that’s not related to your recovery” because we had learned that everything in our lives was related to recovery. Unfortunately this wasn’t the case in AA although some specialty subgroup 12-Step meetings did begin to occur, such as meetings only for women or only for men or only for gay people.
The HIVIES groups, in general, produced a lot of friendships. The work gave meaning to my life, academically and career-wise. When I first went from the addiction world into the HIV treatment world, I attended all the HIV/AIDS conferences for which I was allowed time off. I think it was in 1985 at a conference on AIDS: I’m sitting there, trying to see this connection between addiction and HIV/AIDS. I wasn’t used to feeling professionally out-of-place, but there were just amazingly few addiction colleagues in the HIV/AIDS world at that time. The speakers were talking about PCP, and I was struggling to piece it together - what did PCP, the drug, have to do with AIDS? Finally I embarrassingly asked the man next to me, “Why do they keep talking about angel dust?” [Editor’s note: angel dust is another name for PCP or phencyclidine, a powerful hallucinogenic drug.] He looked at me like I was insane! Finally, I pieced it together: they were talking about pneumocystis pneumonia – nicknamed “PCP” in the HIV/AIDS world! I realized I had a lot to learn! There were a lot of challenges then, but the real challenging pieces, ironically, still exist today. Overcoming the stigmatization of the disease of HIV and AIDS took much longer than anyone thought it would but, eventually, it happened. There was an incredible amount of acceptance that took place a couple of decades ago with AIDS; sadly, I can’t say the same has been true with drug issues.
It is more than a little distressing that this same level of acceptance around drug issues has still not happened. In the face of death, you would think many more people would be talking about this issue, too. I started working for the Illinois Alcohol and Drug Dependency Outpatient AIDS Project with Bella Celan, a wonderful lady. I was 26 years old and Bella was a refuge from Nazi Germany, and she moved up here due to a friendship she had developed with a professor at Northwestern University [Editor’s note: Evanston, IL]. It was a wonderful time. Bella and I were doing this work together, and one of the things I wanted to do was a survey of methadone treatment programs to see how people had dealt with the HIV pandemic. My caseload at the AIDS project was showing more and more people infected with HIV. This was in 1985, and we had a research project with Emory University in Atlanta that said on intake we would ask if people were interested in having their blood tested for AIDS. Nearly everyone was interested and so got tested. Six weeks after intake, the lab slip would come back with the results: HTL-3 antibody positive or negative, so we learned about people’s HIV status right at the starting point, when it first impacted people. We also began to incorporate their status into their methadone treatment plans.
I remember this Puerto Rican man saying to me, “How can this be? I’ve never had sex with a man at all.” I had to say I didn’t know – because we didn’t know back then that people could and were contracting HIV from drug use and not only gay sex - and then later, of course, we found out that his injection practices very clearly put him in line with being at risk for contracting HIV. We were just on the cusp of awareness of HIV. This combination of HIV treatment with addiction treatment became a sort of sad reprieve in the storm of punishment and incarceration and repression, of brutal and ineffective drug treatment; the wave of calm was, ironically, HIV. All of a sudden, people were taking a step back to consider whether they were willing to have any compassion – for either HIV suffers or drug users - and redefine their professional roles in terms of whether they had any empathy for these clients. It was a fascinating and powerful time in drug treatment.
After leaving the position at the AIDS project, I found an internship, which was required for my counseling education (I had recently begun my studies in drug and alcohol counseling towards certification). I went to Cook County Hospital [Editor’s note: Chicago, IL] with a goal of learning how to combine my work experiences in psychology, HIV and drug use into something useful for the patients there. HIV, mental health challenges, and drug use were certainly issues that existed in big ways in Chicago’s Cook County Hospital, so I felt confident that this internship would be enlightening, to see how Cook County was dealing with them. However, I found out very quickly that just because those issues existed, it didn’t mean that hospital workers were dealing with them. I saw that there was very little chance of combining these important patient issues for a host of reasons, one of which was that the man in charge of the drug treatment portion of the hospital was going around acting like a preacher, coming in with flowing robes to proselytize the masses! The typical outside aversion to addiction treatment is still the quasi-religious nature of much of it and, after seeing him, I could certainly see why.
So, after working in various aspects of addiction treatment – inpatient, outpatient, substitution and drug-free - since 1980, I just never felt that we were treating patients the way we would like to be treated if we were patients. These were all difficult situations for me. It seemed as though treating people with respect was seen as less-than-helpful, or even in conflict with these treatment programs. We have learned in recent years, because of Miller [Editor’s note: William R. Miller, co-author, Motivational Interviewing] and others, that these confrontational methods are just bullshit. Even with William L. White [Editor’s note: a well-known speaker, author and prominent historian on treatment and recovery who lives in the Chicago area; author, Slaying the Dragon: A History of Addiction Treatment and Recovery in America.] living here in our neighborhood in Chicago, people still think that harm reduction is for people who are too pathetic to change.
We know what works, what actually helps people make changes in their lives but instead treatment providers act like police, not trusted professionals. The question is, “Is there room in our treatment programs for a cost-effective, humane treatment program that is effective without any of the harassment that is such a part of the current system?” We’ve shown that a harm reduction program can be both cost-effective and easily integrated into traditional treatment, yet we still aren’t able to even say the words “harm reduction” and obtain Federal funding. In the UK, providers are free to prescribe heroin, but very few do probably due to a fear of harassment. Here in the States, we don’t even have that option available to doctors, even if doctors felt it was medically necessary.
It was only through the combination of HIV and drug use that I became motivated to advocate for change in drug treatment and prevention. There were only about a dozen of us - through HIVIES again - that were interested in some combination treatment, with Perry Tilleraas as the catalyst. Most of us were there for support-type issues: we were there to get support and to give support. We were amazed to think that this idea for treatment that we had “hatched” in HIVIES could really be something that could actually come into practice; we were all just talking about this over coffee! A lot of people were not satisfied with just this idea of support though. One analogy was that “people are falling off the cliff so what are you going to do?” Someone said, “Why don’t we put up a fence to keep people from falling?” The end result was to ask if a group like HIVIES was necessary for people to survive. We decided to meet to talk about it. There was a restaurant in Chicago called Ann Sathers and its owner, Tom Tunney, was very generous, giving us and so many people space. So Tom said, “As long as you guys need it, I’m happy to provide sweet rolls and coffee and give you this room.”
At that first meeting, it was magic: we were a no-nonsense group and a magical combination of people. Again everyone was touched, in one way or another, by either drugs or HIV, or both. There were people in that room that night who were intellectually gifted and there were those who were emotional sayers of the times. This was the first time we had people from both drugs and HIV together, and it was the first time that we had people asking if such a group was necessary. Actually somewhere during the process, I called the folks in Minneapolis (MRA) and asked what they would think about our using the name Chicago Recovery Alliance, and they said they’d be really honored by it; they were thrilled. And so, CRA was born, as was the first support group in Chicago for people with drug and HIV problems.
As to the question of whether a group like this was needed, we all said, “Yes, absolutely!” We agreed that our one unifying belief was that the group had to be action-related - it couldn’t be just another meeting. The power of this positive change was equalized; it was respectful and allowed people to define for themselves what was a positive change. Really, there was no alternative to this meeting at the time. Many people today think that it is their ministrations that are curing people, despite all the evidence to the contrary. This alternative, CRA, put the idea of recovery in each person’s lap: recovery became personal. There is something so sane about that. But it required something that is both the crux and the challenge in addiction treatment today: it requires that we hear people. And we need to not get in their way. We also began to see that the best guide to getting people interested in some kind of recovery was to present as many options for recovery as possible. We began to see that as professionals, that’s our job: remove obstacles so people can recover themselves. That is such a huge thing. George Vaillant, who wrote The Natural History of Alcoholism, should be in this discussion. He said effective treatment isn’t the curative efforts of anyone other than the clients themselves. Those are the results of his longitudinal studies.[i] And I’ve certainly seen this to be true in my professional work.
So, for me harm reduction is the practice of providing as many options for positive change as one can. In our case, it is about assisting the reduction of drug-related harm, but it doesn’t have to be. Harm reduction can be anything in any field that reduces harm to the individual or society. For example, many people are killed each year in the US due to automobile accidents. Yet we don’t outlaw cars. Instead, we opt for laws and training to help people remember to wear seat belts, shoulder restraints, and to simply drive defensively. That’s harm reduction, both for the individual and for society at large. In addiction treatment, we have the ability to help people reduce the harm to their lives from their behavior and gain access to that assistance by working collaboratively toward any positive end. Both the topic and the intensity of the treatment must be determined entirely by the person seeking help. Also, we need to be providing this engagement through a reflective feedback system, an alliance to facilitate any positive change as defined by the people themselves.
Bill Miller might call this a “bouquet of options.” What I’d say is that the quantity of those options is also important. To me, this idea of the options we give to clients is rather like setting out selections on a banquet table: we need to think of all the people who are coming to eat, not just the vegetarians or such. So, someone may want a little taste of the mashed potatoes, and someone else may want a whole plate of it, and someone else wants none at all. We need to offer something for everyone, for all different tastes. You can also make multiple trips to the banquet table, so treatment needs to be open-ended with the understanding that it’s also okay to throw out the whole plate and start fresh. What’s really important is that the clients, like the buffet eaters, make their own selections. So many programs are basically serving up food on your plate for you, rather than just guiding you to the table and showing you the options. That guiding toward any positive change is harm reduction, and that’s what real treatment – and treatment professionals - should be doing.
Dan Bigg was the Director of Chicago Recovery Alliance (CRA), a no-threshold harm reduction information and needle exchange organization in Chicago, IL. See www.anypositivechange.org for more information.
[i] Exact quotation: “Neither the efforts of dedicated clinicians nor the individual's own willpower
appear to be able to cure an alcoholic's conditioned habit at a given time. Our task is to provide emergency medical care, shelter, detoxification, and understanding until self-healing takes place.” George Vaillant, The Natural History of Alcoholism, 1983, p314-5.