HRTC was born out of a need to create a completely different way of working with people who use drugs.  It’s founders, Patt Denning and Jeannie Little, were working with extremely stressed groups of people – gay men in the Castro in the 1980’s, ground zero for HIV/AIDS before we had effective treatments, and homeless women and veterans whose levels of post-traumatic stress was very high.  Our clients taught us that the belief that addiction is a disease was dangerously simplistic and completely unacceptable.  Patt and Jeannie, listening to the voices of their clients, threw out “the book” entirely and began creating something very different.

In 2000 they created Harm Reduction Therapy Center,  a non-profit mental health and substance use treatment organization created for people who, because their relationship with drugs is so intertwined with other emotional and social aspects of their lives, need more than simple “just say no” advice and programs that require you to commit to the goal of abstinence before you’ve even explored the problem.  Firmly rooted in the values of self-determination, we meet each person where they are, we accept them wholeheartedly for who they are, and we empower people to define their own problems and discover their own goals.  

HRTC recognizes that the treatment system mirrors the War on Drugs.  The U.S. policy of “just say no” led to laws that, for the last 100+ years, has caused the arrest and imprisonment of millions of people, most of them black and brown people, for the “crime” of engaging in what is a health condition, not a moral or legal issue.  Abstinence-only treatment programs that use exclusion and punishment to try to force compliance with a lifelong goal of abstinence, completely miss the complexities of each person’s relationship with drugs.  And, in a further harm to health, this clinging to abstinence as the only outcome of drug problems leads mental health and medical providers to refuse to treat people who are actively using drugs.

 

HRTC’s vision is a just healthcare system that excludes no one, regardless of the status of their substance use or their mental health.  We also know that “not excluding” is not the same as actively inviting.  We keep central to our vision the fact that the systemic racism in our country and in our health services has caused many people to avoid care because their experiences lead them to not trust us.  We work hard to provide an experience that people can begin to trust, by actively seeking out and responding to the stated needs of African Americans and other marginalized groups.  To that end, HRTC has modeled the development of harm reduction therapy programs to fit the needs of every individual and every community that uses drugs, to work with families of people who use drugs, and to train other health professionals and programs that want to work with people who actively use drugs.

The Harm Reduction Therapy Center is a model program.  We have perfected four key principles and practices that define harm reduction therapy HRTC-style —

Integration

We have integrated mental health and substance use treatment so that people with complex interacting problems don’t have to go through an endless revolving door of traditionally segregated systems that demand resolution of one problem before being eligible for treatment of the other.  Our staff of 15 mental health professionals are highly trained in drug and alcohol use and misuse and in the treatment of trauma.  We are known for our willingness to work with anyone on whatever problem they deem most urgent.

Low Threshold Treatment

Not only do we meet people where they are in their relationship with drugs, regardless of their goals for future use, we also have a completely open door policy.  We work in community-based drop-in centers where there is no threshold for entry – people simply walk in and say they want to talk to someone.  It doesn’t matter what emotional or mental state they are in or their level of intoxication.  We will greet them warmly and find out what they need.  In this manner we begin treatment.  Most recently, we have taken our therapy to the streets of San Francisco in the form of mobile pop-up mental health centers with a growing array of multi-disciplinary medical and social service partners.  

Collaboration  

Over the last 21 years HRTC has created long term partnerships with community-based organizations where we embed our therapists in their programs and serve as the onsite mental health team for clients of the agency.  We also train and support host staff to better understand and work with people experiencing mental health and substance use crises. 

HRTC’s Community Services programs demonstrate a very unique model.  We work alongside multidisciplinary teams – doctors, nurses, peer counselors, social workers, case managers, substance use counselors, shelter and camp monitors, and more – in a broad range of settings: from medical clinics to drop-in centers, street outreach, and supportive housing.  We have found a niche in our ability to work side by side with people from all professional and personal backgrounds.

Teaching and Dissemination 

Patt, Jeannie, and HRTC staff have also forged and maintained considerable influence in the academic sphere of Harm Reduction Therapy through consistent publishing and research.  Beginning in 2000 with Patt’s groundbreaking book,  “Practicing Harm Reduction Psychotherapy”, and continuing with 3 more books and many articles and book chapters, we continue to evolve and write about our findings.  Most recently, a research group founded by HRTC has published the first research project on harm reduction therapy.