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Episode 24: Sheila Vakharia Connects the Dots between Harm Reduction and Social Work
"Mm-hmm. Welcome to drugs and style a podcast from the drug policy alliance. Blue and welcome to another episode of jugs and stuff the podcast from drug policy alliance. My name's Gabriela Mira's, I'm the manager of multimedia design here at DPA, and I'm so excited to welcome my colleague, Dr Sheila Ikaria Sheila is a researcher at the office of academic engagement here at DP. A and she has such an interesting background. She started as social worker and moved into academia and finally ended up here at DP. A and she's an incredible asset to the organization. Thank you so much Sheila for taking the time to speak with me today. I'm happy to be here. Thank you. Great. So Sheila, you have a really interesting background kind of the road that you took to get here. So I'm just going to dive right in and ask, you know. How did you end up in your current role at DP like what's the road that got you here? Wow. Well, that's a big question. I feel like in. No way was it a straight path or one that I could have envisioned or imagined for myself. I feel like when I look back and try to leave a cohesive narrative to really understand how I got here. I I sometimes have to stop and reflect and think about what was going through my head when I made that decision because actually my background is in clinical practice. So when I was growing up, I thought I was going to be therapist. And so in thinking that believing that seem natural to me to choose a bachelor's degree in clinical and social psychology and to dig deep into these different theories of human behavior to learn different clinical counseling skills because that really just felt like where I wanted to be. I wanted to help people wanted help people solve problems, and I wanted to build relationships with people, and so clinical psychology seemed like the best fit. I had lots of internships over. For the summers. When I was in college at different clinical placements, I had his summer internship in London at the detox at the Florence Nightingale hospital, which I was really formative for me because I think it was really my first exposure to working with people who use drugs and people who are trying to figure out how to live lives without drugs. And prior to that, I really hadn't had much personal personal exposure to drug use let alone perhaps problematic or chaotic drug user addiction. And I felt like it really opened my eyes. I and so many different kinds of people received services that detox all different walks of life, all different kinds of experiences, and here they all were receiving treatment together. And although it was a really interesting experience. I still hadn't even after that experience necessarily decided which population I wanted to work with clinically. But it definitely was one of those things that stuck with me. And then it was time to go to grad. The school because unfortunately, at least in the US, you can't really do much counselling or clinical work with a bachelor's degree. And it was then when I heard of social programs that I realized that a lot of my internships, actually were with social workers MSW's people who were doing the clinical work, I was interested in, but who are also committed to addressing social Justice issues who understood the role of race class gender structural oppression and various other systems, and it seemed like social work was the way to go. And so I got my MSW and again funny enough my second year, internship, ended up being in drug and alcohol treatment setting where I was working in an outpatient modality and folks were coming in for treatment. And I was there to do a Susman's in groups and again very much in the clinical work. And then realizing, you know, why it maybe maybe working in the field of addiction is actually something that I'm actually really interested in maybe these are my people, and I did that. But the challenge of working in that setting for me was that I was realizing that most of my clients were mandated to treatment and being mandated to treatment and meant that they were often choosing treatment over jail, and or often choosing treatment over having a lose their kids or choosing treatment because it was a way to get access to the social services that they needed, and I realized that that wasn't really choosing treatment at all. And that people aren't really being given choices and that I was complicit in systems that we're using treatment as as a means for control and part of how we were also providing treatment was really grounded in twelve step orientation, and there's nothing wrong with twelve steps. And a and a However I felt like that was the only tool in our toolbox for teaching people how to think about their drug use and their experiences, and I really struggled with being provider who was telling people they had a disease and that the only way to address their disease was through. Rendering and accepting their powerlessness and going to meetings, and that they could never use any substances ever again. And I was really getting disenchanted, but I still wanted to do the clinical work. And so in this kind of rash move. I just wanted to leave leave the setting do something different. And I was like let me move to New York and see what kind of jobs, I can find. And so I got a job at a needle exchange complete one eighty and the the logic. But I that guided that decision if I can tell you what was going through my twenty four twenty five year old brain was that if no one's mandated to come here and people are coming. They want syringes then people will come and get what they need. And there's no there will be no pressure on them to to to to be there on anyone else's terms other than their own and that perhaps could have real relationships with my clients grounded in respect and choice. And atonomy rather than in being forced course to be there. I mean oftentimes in the previous setting that I worked in. I was the one calling PEOs and telling them that my clients had tested positive on a drug screen because that was part of my job. I was behold into those systems to and so I was like, well if no one's watching over us. Maybe we can actually do some really good work and really get to the issues that are of concern to folks. And so I did that and over the years of doing that gradually became acting director of the needle exchange and realized again, maybe administration wasn't the top goal for me like running a program wasn't my key strengths. So I started reevaluating. What do I wanna do? I still want to do therapy. Do I still want to work in the nonprofit sector? What do I wanna do? And it was then when I spoke to my mentor, and he said bull. This doesn't just have to be the only path for you. Have you ever thought about getting a PHD? And so. Oh, it was at that moment that I thought maybe yes. 'cause I really didn't receive a lot of count content on addiction or substance use in any of my clinical training, all all that. I learned about addictions with through my direct practice in any studying that I did on my own. And he's like, well, maybe you need to be the voice of harm reduction in social work. Maybe you need to be that professor who teaches exposes students to a different way of looking at substance use and looking at their clients and looking at their work. And so that's what I did. I went got my PHD, and then I got a job right away at LSU in Brooklyn. And I taught classes only two students in the w program who are interested in substance use. And I got to talk about drugs and addiction and away that was informed by harm reduction. That was informed by the evidence that wasn't fearmongering. That was an extreme that was really about compassion and working with people where they're at and I loved it. But I also started getting a little itchy there in that. I was like is this. Is this what I wanna do is? Is there more for me? And so in my free time, I started getting involved in the community volunteering learning about different events that were happening being hosted by different organizations like DPA going out and learning about drug policy in a way beyond just what I was learning when I was going through my PHD program about what people were doing to address the issues of today and through all of that. I just realized there was still more that I could offer beyond what I was doing an academic teaching the next generation of social workers, I could be affecting change today in a different way. And so when the position opened up at the office of academic engagement, and I was heavily heavily persuaded to apply. Yeah. Opted to make the change. So that's a bit of a long long explanation of what brought me here. But in no way, was it a straight path there were various points when I thought, oh, this is just going to be the job that I'm going to have. And then something happened. And I didn't want to do that. Anymore? That happens to a lot of us. I mean, it might be a meandering path. But when things don't quite feel like the right fit you to move on to something else. That's pretty amazing. So you talked about how you know, you didn't really have a lot of exposure to people who use drugs those kinds of populations especially problematic drug use until you are working in London. So before all of that, you know, even growing up what were your kind of ideas about an around drug use? I I had friends who socially used. And so I definitely knew it was a reality for some people to wanna try substances or twenty use them. And of course, all of this being the same time when I was an alcohol user, right? So. I think I had an internalized as much stigma as other people had about illicit drugs or the drugs that are are not legal. But I think that because I knew people who use them and who were fine. Good people and people who were important to me in my circles that in my networks, but there was still a lot that I needed to to deconstruct even when I did move into the treatment settings. And even those of us who think were the most open minded realize the areas where we need to grow and change, and dispel myths and stereotypes and so much of what I learned from working with Miami's in clients over the years, but also all the reading and self taught stuff that happened over the years really helped me to challenge so much of what I believed. So I'd say that. I perhaps was more open minded than some. But I could have been more open minded, and thankfully, I had experiences an openness and a willingness to challenge them to get to where I am today. And I still know that there's probably plenty I need to still work on. Yeah. I mean, it's a process, right? We're always growing and changing in our in our perspectives and our beliefs in working as a professor at LSU. What were some of the misconceptions or stigmas that you've found that your students held and were they able to challenge. Those over the course of in learning from you. Yeah. I mean, definitely my students. Some of my students had more personal exposure to substance, use and problematic. Houston addiction than I did. Some of them came with their own lived experience of identifying as being addicted once or having substance use disorder. Plenty of people talked about having family members or loved ones who had. Who had either gone through a period in leg in their lives? They used problematically or were currently, and so, you know, working with them to to be able to put aside sometimes our own very challenging and painful experiences and to think about how can that help me be better in my own clinical work? And like, what do I see is like the areas that I still need to grow into able to truly put myself in this work and treat every client in front of me like a new person, and and not bring perhaps my old kind of transference. My own counter. Transference rather into my work because I think that the more we work in fields that are very closely personally tied sometimes it can bring up a lot of her own personal issues that can then play out an impact how we provide services and how we work with clients. So I did spend a lot of time with my with my students talking about how their own personal experiences can sometimes play out. In their work, which was. Interesting and important to to do. But also they held a lot of the same stereotypes and myths that I did as well. You know, we were all products of dare, you know, we all had gone through this, you know, through this so called, you know, prevention programming that taught us that, you know, certain drugs. No matter how many times you've done them are fundamentally addictive sustain away altogether. You know, this idea of hard drug versus soft-drug ideas about the permanence of of having a problem that it can that only treatment can help you overcome it when we know that actually the vast majority of people who develop problems to substances also resolve those problems without treatment, and that for many as well abstinence isn't necessarily the path to their recovery's. Some people can still use other substances or can cut down or moderate their use of the substance did once cause a problem for them. I think I also had to work pretty hard on dispelling ideas about harm reduction, and what it means to give someone a sterile syringe into be with them and know that they're still using and to sit with them into feel like you're still working towards change in progress, and that change in progress in recovery can look different for different people, and that truly connecting and helping people can look like a lot of different things, and that helped doesn't eat to look one way. Specifically when you're talking about people who use drugs, so that was a lot of a lot of what I worked on with my students. Yeah. I mean coming from this deep social work background. But also having such a passion for harm reduction and kind of the the research and science behind addiction and substance use. How do you feel that you're very unique background in? I mean, do you feel like you are a unique kind of like a unicorn in the field where you have the you have this kind. Varied background or are there? Others like you. I think everyone in harm reduction has an interesting funny quirky story. And so mine is my own quirky story. I do think that perhaps one of the things that he distinguishes my experience from others is that first of all I don't have an addiction background myself and still chose this work because I do feel like it's very rare to find people who choose clinical work in the addictions, and particularly in harm reduction who don't have some personal connection. Some people kind of know that they're really interested in research from the beginning or they choose research. That's clinically informed after they've been to clinic like done clinical work. So I've been a clinician. And now I want to do research on therapy is a pretty direct path, but choosing to shift all the way to policy can make it a little different. So there's a few little points in there where I don't always see people or meet people who have made those same. Leaps, but we all have interesting stories. That's definitely true. I mean, that's why we got you here today. Talking to us. Yeah. You're definitely interesting. So you're a self-described in-house nerd at DPA. So what about research and kind of policy the policy side is so appealing to you. And what you know both. What do you love about it? And also what kind of challenges and limitations? Do you find that? It has of course, bursaries it's a little different than working kind of one on one in those kinds of setting. So any thoughts on the? Yeah. I mean, I think getting the PHD and deciding that the PHD was the next step for me made me realize how interesting methodology and design and questions can be and being able to explore the answers to questions Ted to discover something new. I don't. Think I necessarily had that appreciation all through my undergrad, even through my MSW. I don't think I was really all that interested in research. It was something that evolved as a result of my experiences and understanding that there were still so many things that we didn't know, but understanding how much did. No. And how he had found that out. But why was it that so much of the good research that supports harm reduction and supports humanistic approaches? Why wasn't that as readily accessible, and why was it that people still struggle to accept it? I think all of those things drove Nida to research. And I think one of the interesting challenges of being a researcher here at DPA is that despite all these piles and piles of studies that we collect and read and and think through their implications for policy, and what that all means is that fundamentally at the end of the day very few policy decisions are actually guy. Added by research. It's often that it's values and emotions and feeling persuaded. But it's not always numbers that persuade people. It's often stories and things that you've experienced that do so it's a funny contradiction. I've come to value research so much at something. I think about a lot I spent a lot of time reading it. I know how important it is. I love talking to researchers learning about them learning about what they're doing. But it's this funny contradiction in that it's so important to me, and it's obviously important to this organization, but it's not always what guides policy. So it's this also this tragedy. Oh, yeah. I mean, we even see especially today like in, you know, our current administration government administration. There's there sometimes what feels like a blatant disregard for things based in science and factually based things it's just you know, if people are choosing to ignore certain things than what can we really do other than continue try, so. Yeah. So it's it's funny. How yeah. Part of my job is to constantly be calling the literature. Seeing what's out there finding studies that support our work or finding studies that could challenge our work and thinking about what to do with this information are the studies that challenge our work or perhaps contradict some of our stances or that would make our policy. Stances more challenging to sell are the study's actually really well designed. Is it just that certain studies got a lot of press because there's something flashy about the headline or the university that that hosted the researcher had a really good press office that was able to put out a press release in journalists picked up on it. But upon closer examination are the findings really persuasive. Are they truly grounded in strong methodology the analytical approach really come to these conclusions. So so that's that's another element of job that I find really really interesting is even when studies sometimes look like, you know, oh, what are we going to do with this data? Sometimes it's also about thinking through was designed in a way that that is really telling us this information or could this have been designed differently. So yeah, I get to use lots of different parts of my brain in thinking that stuff through there ever been any instances, whether it's since working DP were. In your previous jobs, where something that you've read or researched has really caused a shift in in the beliefs that you hold. Yeah. I mean, I think the book that really one of the books that really changed the way that I think was vote by Stanton Peele called the diseasing of America. And actually there were quite a few books that I read during my doctoral program that changed the way I think, but I the way in which he really questioned this permanent lifelong disease state, and that actually there's a history to looking at addiction as a disease that is rooted in older spiritual traditions rooted in Judeo Christian beliefs of some of our founding fathers here the ways in which the evolution of alcoholics anonymous, actually influence some of these. Models. But also was influenced by these models the ways in which we as a society are still dealing with the fact that we have a medical system that's trying to tell us that addiction is a medical disease or that, you know, the National Institute of drug abuses, telling us here that addiction is a brain disease. And then we have folks in the alcoholics anonymous and narcotics anonymous, the twelve step world who say that it's actually a spiritual disease, and that perhaps people have certain predispositions, and this idea like what is this construction of disease really due to sometimes be a helpful tool in getting some people to kind of understanding conceptualize their own experiences or those of others and in what ways can it help build compassion. But in what ways can it still be used as a weapon to stigmatize and one to justify coercion paternalism and doing things for. Someone's own good because they don't know what's better for them. So I mean, I'd say that that book was really influential and in getting Nita think all of this through because even though I've worked in a traditional treatment setting where we did talk about the disease model addiction, and as soon as I left that for harm-reduction setting just through that construct out of my vocabulary unless my clients wanted to talk about, you know, having a disease, and then it was like, okay. Let's let's explore what that means to you. But I'd never really thought about the roots in the origins and the ways that Severi. Even the idea of addiction as diseases very American and a uniquely American construction. I just never had thought any of that stuff through anti-fouling that that book was really I opening for me. And really took me on a course to start reading different people of who wrote about theories of maturation that people can grow out of of substance use that a lot of people. You know, you you have to contest July's someone's experience of addiction or problematic use within what else is going on in their lives. What other circumstances? What's happening that oftentimes substance uses a proactive response an attempt to cope? Yeah. Anyway, that I say that that opened me up. Yeah. So you mentioned earlier the idea for your own good and coerce treatment. And we have a conference coming up on San Francisco. Oh may sixteen lay sixteenth seventeenth. So can you talk a little bit about that? And kind of the idea behind it. And what kinds of things will be explored there? Sure sure, I'm part of the planning committee. So I do have colleagues on my committee who would probably be better suited to answer more detailed questions, but what I can tell you is that increasingly across the country, as you know, awareness seems to be growing that, you know, people with untreated substance use disorder need help what we're seeing is increased bills and laws being passed across the country that allow for putting someone into holding. If you think they're in risk at risk for harming themselves or others or bills like the one in San Francisco, which is a conservative ship law that kind of wood again coerce people with untreated, mental health and substance use problems into treatment against their will. And so our colleague Laura Thomas who's the deputy? Rector of our California policy office was really concerned about seeing this happening in San Francisco. And so she pulled together bunch of us colleagues to say like why don't we put together a conference that challenges idea that coercion is the only way to get people to get help. And why don't we bring together some of the best minds in both the mental health and disability spaces and in the substance use spaces to talk about the research of coercive treatment will we know actually about whether it works or not why don't we bring in people's lived experiences who've had to actually who've actually been subjected some of this coercion and bring together providers and other folks to talk about the ways in which systems can actually really bring a lot more harm than good. And then to talk about what a world free of coercive treatment could look like. And so we've got a series of panels scheduled all day long on the sixteenth in which we bring together. People lived experience providers. Researchers and. All kinds of other folks to present share this information, and then actually on Friday, the seventeenth will have a whole full day of workshops where people can actually hands on talk about ways in which you can make your settings more inclusive for people who might be experiencing crisis. How can you actually get involved with the movement to push back against this conservative Bill being discussed in San Francisco and other kinds of workshops, so we're actually really excited you can get more information by going to vent bright and looking up for your own good. And you can register for the conference all day, it's free, and you can also register for workshops on the seventeenth. Yes. Oh, any of our listeners who are in the bay area hope to see you there. And yes, so I actually saw you speak at a another conference that we recently had around supervised consumption space sites. And I think they kinda share a common theme. Team in that there's a lot of societal whether preconceived notions or misconceptions around these kinds of issues that were trying to combat by looking at them as like a multifaceted kind of concept to know like you might think of it this way. But have you considered these other perspectives or these other sides of the issue? So in your work, you speak a lot about kind of the or focus on the language around these issues, so for you know, around course, treatment or supervise spaces or any other kind of drug policy related issues. What are some of the things that you look out for in in the language that we're using around those issues? So I think we I mean there there's been more generally a move towards person centered language in a lot of mental health spaces in the substance use spaces and in the disability spaces as well. Because the probably use words like addict or alcohol IQ or schizophrenic is that we put first someone's diagnosis there perhaps their health condition before we put that person. And what it does is it sometimes can turn someone from a multifaceted person into a one dimensional person. And what happens is we'll meet turn people into one dimensional beings. They lose the the nuance that we afford ourselves and others, and it makes it easier to sometimes dehumanize them, or to assume that they're not as much like you as they. Perhaps may be really are. It can be used as distancing tool, and it can also make it hard to have empathy and compassion. So, you know, move that we've seen here in the harm reduction space is to to really move away from words like addict an alcoholic and also to to move towards putting the person I and you know, to talk about people who use drugs, right? And when we talk about people who use drugs. And we let drugs be a loose broad category rather than elicit drug or illicit drug or legal drug or illegal drug. We create much more broad ways of understanding substances and the ways in which more people than not Hughes various substances, and it helps us to tear down some of those distinctions. It also helps us resist the urge to label one person's use as as one way versus mine as being another. And it helps us create these broader categories that can then perhaps help us to expand compassion and and care rather than stigma. Although at times, it is important for us to to talk about problematic, you so, you know, people who use drugs problematically or people who may use chaotically or people who might experience. Fiction or have substance use disorders because sometimes it is also important not to minimize the fact that some of us who perhaps can control our moderate are us are privileged in the ways in which we might not then have to experience certain consequences that other people have to write or that. We should also acknowledge that despite the fact that perhaps all people use drugs, not all of us. Equally will suffer the consequences for that use not all of us may equally be targeted or police for our use not all of us will be equally stigmatized for our use. And so by still putting the person I whether it's to say that a person who uses drugs or a person uses drugs problematically, we're still acknowledging someone's humanity. And when you acknowledge someone's humanity, hopefully, it's harder to wanna take their rights away or to justify being tough or harsh or punitive. And hopefully it. Helps us to see that they're entitled to the same things that we are. That's the aim. Yeah. Which I think is what makes what we do here. So much more than just drugs so much more than just drug policy. It's really like a human rights issue is a much larger piece of the puzzle. And the I mean, what do you find most rewarding about about the work that you do here? What I find most rewarding about the work is knowing that I'm helping so it's funny that I'm not helping maybe in the more more traditional senses. But as a researcher at this organization the way that I feel like I'm I'm helping and supporting is by directly supporting my staff, and my colleagues who are out there doing the policy advocacy work in giving them the tools, and the research and arming them with facts and data to go out there and be able to do there. Jobs and to feel prepared in any way that they may need to feel prepared. You know, plenty of my colleagues have a better grasp on the research than I do and have plenty of areas of expertise, and sometimes the most helpful that I can feel to folks like that is to just be like, hey, here's the twenty nineteen paper that came out saying that same thing that you've been saying for five years, and maybe put this in your back pocket too. Whereas sometimes a new study comes out that's done different kind of analysis. That is looking at things a little bit differently. And then I feel like, oh, I'm getting a chance to open my colleagues mine's a little bit to let them know that this new finding came out or this is what this new number this new analysis came out. And this is the numbers so feeling like, I'm helping or feeling like, I'm, you know, supporting my colleagues is I think the best part of my job another part of my job that I really like is being able to plan cool conferences in like the one we just talked about. But I also one of the first things I did when I got. Hired was I was put in charge of putting together our stimulants conference. We actually in September of twenty seventeen in Los Angeles hosted a conference to really focus on stimulant drugs. So what we meant by that was cocaine and methamphetamine and prescription amphetamines and to talk about what it is that we really know about populations that perhaps use stimulants in a high risk manner to understand what harm reduction interventions are best suited for people who you stimulants to explore the best treatment methods that work to help people who might be struggling with their stimulant use. And then to discuss more broader issues moving forward about future treatment needs and things that we need to be still working on in that area. And it was really exciting to to do the research to put the conference together to find the right people to work with my colleagues and identifying who those people were and to see that event through and then to write the recommendation. Paper that came out of it, highlighting the lessons we learned and sharing those because I think one of the cool things about what we do here at DP is we're always thinking about how do we broach the next topic? How do we identify the next issue? How do we stay on the cutting edge, and we did that conference in two thousand seventeen right around when states across the west the west coast and increasingly some states east of the Mississippi were starting to notice spikes in the involvement of stimulant drugs in the overdose crisis, and that although we know that over sixty percent of overdose deaths across the country are driven by opioids and certain parts of the country. It's more than sixty percent. But that poly poly, substance use or poly pharmacy having more than one class of drug in your body was actually driving most of the overdose deaths. And what we're seeing was that stimulants were starting to take up of bigger slice of that pie. And so to be at the cutting edge of that conversation about what we what we know. About stimulants. Would we not know about stimulants had a treat them how to help people who are still using to stay safe and stay alive was really exciting. And I feel like it's I think it was an important conversation for us to be part of. And I'm glad that we were part of it. And that and that we as an organization are thinking that through. And I think that with this coercion conferences, well, we're just trying to to be in the conversation to bring the right people together to think these things through as well into raise awareness among the public that. Although sometimes it may feel right to to to make decisions for other people that actually there's a lot of ramifications to that. And that there are other models that we could be adopting to to really get people help if that's what we want. But sometimes we talk about coercion. And we really mean punitive nece too. And I think we need to challenge that as well. Great. Thank you so much Sheila. It's just wonderful having you here, not only on the podcast, but you know, at drug policy alliance. Says such a voice of compassion and curiosity, and you know, I think what you said about being open minded and challenging your own beliefs as well as others beliefs is something that is really crucial in this fight. That's ongoing. You know? So thank you. Thanks. Thanks for tuning into today's episode and huge thanks to our mazing guest. Dr Sheila Ikaria, if you wanna learn more about the multifaceted work that she does you can follow her on Twitter. She's very active you can find her at my harm reduction. And we really wanna hear your thoughts on this episode and any other episodes we've done or should do in the future. So check us out drugs and stuff DPA on Twitter. And let us know if you have any suggestions for guests that we should have on. Or if you have any questions for us. We're happy to answer those on the air. So stay tuned. Thanks for listening and stay open minded. Drugs and stuff is brought to you by the drug policy alliance. If you like what you hear in the podcast favorite rate the show on I tunes gave it five stars. And a nice review. Also, we'd love to hear from. You tweeted us at drugs and stuff DPA use the hashtag, drugs and stuff and check out our website, drug policy dot org to see the other work. We do Santa for emails and donate special. Thanks to our producer, Katherine Heller and the hardworking staff of the drug policy alliance for all of their work. Thanks for listening.