Words by Holly Harrison

Unfamiliar with the principles of harm reduction? Don’t blame yourself. Like Valhalla Place‘s Adam Fairbanks says above—it’s not common in Minnesota. It’s not common in many places, actually.

Here’s the gist: harm reduction is a set of strategies and ideas aimed at reducing the negative consequences associated with drug use. The strategies cover the spectrum from safer use to abstinence, all depending on what a person who uses drugs is ready for. By acknowledging that—for better or worse—drug use is part of our world, practitioners of harm reduction work to minimize the harmful effects of drugs rather than ignore or condemn them.

Valhalla Place’s harm reduction services branch looks like this:

• Once-weekly syringe exchange: trained volunteers provide sterile syringes and collect used syringes, curbing the transmission of HIV, and hepatitis B and C
• Education, training, and access to Naloxone (AKA Narcan): a harmless and effective medication that reverses an opiate overdose
• Harm reduction therapy: group and individual mental health services where people who use drugs set goals and pacing together with counselors and clinicians

“When I started my career eleven years ago, I used to bang my head against the wall trying to force harm reduction into the traditional recovery world,” Adam says. “But over time, things started to change. Valhalla started. There have been more books written and more research and evidence to support it. It’s not as lonely anymore because now I’m surrounded by 150 employees who get it.”

Read on for a Q&A with Adam, Director of Harm Reduction Services at Valhalla Place, on what harm reduction looks like, what he’s learned during his career, and how laymen can practice it in their lives.

How did you find yourself at Valhalla Place?

I met [Karen Greenstein], the owner of Valhalla Place, when I was doing HIV work. A friend of mine who did street-based needle exchange underground contacted me and said, “Hey, I got a donation of syringes. Can I put them in your garage?” And I said, “Absolutely not. But I may have an idea.” So I called Karen and said, “You just opened a new clinic, and I know you probably have space. Can I store these in your clinic?” And she said, “Sure.”

I would pick up the needles once a week and deliver them to my friend on Fridays. After a while I was like, “Man, I really like the concept of having syringe exchange embedded into a treatment facility.” I volunteered once a week on Fridays doing the needle exchange with other volunteers, and it was well-received at the clinic. Shortly after I started doing Narcan training. I did that work for about nine months and then I was offered the job as director of harm reduction services.

My job is to create programming that engages our target audience—people who use drugs, especially opiate users—and gets them to walk in our doors and access our services. We do that by providing things that they want and need, like syringe exchange, which is something that nearly all injection drug users want access to and something we can provide for free. We tell everyone our objective—they’re encouraged to enroll in our services when they’re ready, to transition from using illicit drugs into medication-assisted treatment, so they can become stable and get into recovery.

Tell me about the community that has sprung up around your services.

I think of three communities that have sprung up as a result of our services. One would be the clients that we serve: people who are using opiates and who want to access harm reduction services. That community—people are more independent and alone when they are in active use. So it is a community, but at the same time it isn’t like the same feeling I get when I’m at the overdose vigil, where you have people who have lost loved ones and they’re there to support each other.

Especially if, at least how I understand it, one of the driving forces of addiction is isolation. So it’s hard to build a community of people who feel isolated.

But at the same time, people who use drugs do support each other. They do care about each other. A lot of people don’t understand or forget that these people are friends and they care about each other. Even though there’s drama, it doesn’t mean that when somebody dies that everybody’s not affected. People don’t think about that.

At the [August 31] vigil it was primarily just family members, who I would identify as the second community. At some point I would really like there to be a strong drug user presence there. Because I know that—when we do needle exchange—I know how impacted and upset they are when someone overdoses. And they don’t have enough people to talk to about that. And generally they aren’t connected to any professionals. Which is why Valhalla Place is trying to create other opportunities to get people involved in services, even if they’re not ready to stop using drugs.

In addition to people who use drugs and family members affected by overdose, the third community is professionals. There are a lot of individuals involved in traditional twelve-step programs locally who are supportive and “get” harm reduction. I talk to people all the time who love what we’re doing and think it’s awesome but work at an organization that doesn’t support it. That community is starting to build. [Valhalla] is kind of leading the way, because we’re so out and loud about the fact that we are a harm reduction agency.

What are some of the common misperceptions around harm reduction that you find yourself debunking a lot, or would really like to see fall away once and for all?

That it’s either abstinence or harm reduction. They’re the same. Abstinence is obviously a major form of harm reduction. If people are abstaining, they’re not using drugs, and if they were using drugs before they’re reducing harm by not using drugs now.

But there’s this tension because harm reduction challenges what they teach people in traditional recovery. What we teach people is that you can use safer. You can reduce harm. You can be empowered to make better decisions. And the traditional model is that you are powerless from these drugs and it’s only going to get worse. So people in the abstinence and traditional recovery model communities look at the work that I do as a threat to what they’re teaching people.

It doesn’t always get worse. It can start to get better. People can start to make better decisions. If people are not informed about the risks of overdose, their odds of overdosing are significantly higher. And traditional recovery-based programs are afraid to provide that education because they look at it as encouraging drug use. The way I look at it is we’re just telling people how dangerous it is, and how to reduce harm.

Your organization uses a non-judgmental approach. What does that mean in practice?

I would say the biggest part of that is non-punitive. We do not take punitive measures unless it is mandated by a regulating agency like the DEA. Like, if somebody has a positive drug screen then the state expects x, y, and z to happen. We follow those rules, but we don’t go above that. We don’t believe that punishment is a good approach for helping people.

When I’m working with the needle exchange clients and the volunteers, we will educate them about the dangers of drug use, but we let them make their own choices about it. We make sure that we never have that look on our face like, “Oh man—what are you doing?” Y’know what I mean? “Why are you doing this?” We never ask that question.

We accept the fact that drugs are part of our world. We accept the fact that people are, for various reasons, using drugs. And we make sure that we are very empathetic and supportive and let them know that we care. We meet them where they’re at.

If they’re in total chaotic use, and that’s where they wanna be, we give them needles. If they are sick of that lifestyle and they wanna make some changes but not necessarily go to treatment, we will connect them with a therapist. We just let them guide the path that they’re traveling on.
There’s a model in our organization called “It depends.” [Instead of having strict treatment protocols,] we allow our medical providers to use their clinical judgment. We allow our drug counselors to use their expertise the way that they were trained.

Can you talk about how laymen can apply the non-judgmental approach, instead of sitting people down intervention-style and telling them to shape up or else?

There’s not a single way to address the issue. You can’t just think about harm reduction for an individual [who uses drugs]. You have to also look at harm reduction for a family. For a community. For public safety. There are a lot of different approaches.

It’s not effective to tell people what to do. Sitting them down scares them away. If you wanna be able to help people, they have to be willing to listen to you. That starts with you listening to them, without telling them what’s best for them.

By Holly Harrison

Photographer Kristina Barker sees South Dakota—really sees it—and captures it in a way you won’t soon forget. Her photography of the Black Hills is at once wild and familiar. One photo looks plucked out of a Western, too untamed and too perfect to be real. The next is routine, but uniquely intimate—a family of ranchers praying over their dinner, a Sioux Tribal Police officer shedding her uniform for fancy dress regalia.

Kristina’s spent eight years criss-crossing South Dakota, and it’s rare that she’s not armed with her camera. It’s a lucky thing, too. For South Dakotans, her photography is a stirring tribute to home. For everyone else, it’s a glimpse into the Mount Rushmore State so vivid you’ll want to follow Kristina’s lead and move out to the Edge of the West.

Why did you come to South Dakota, and why did you stay?

I have long been in love with the rural West—I find the stories and the people incredibly captivating.

I was finishing my degree at San Francisco State University in 2007 and knew that I wanted to go out of state for my first job after college. I wanted to work in a newsroom that was focused on its community. South Dakota quickly rose to the top of the list where editors had expressed interest.

I moved here in January of 2008, with a U-Haul and my six-month-old puppy, Moco, and began working at the Rapid City Journal. I gave myself the goal of staying two years, but clearly I’ve surpassed that goal. South Dakota feels so much like home, more than the Bay Area ever did.

Your “Edge of the West” photos go everywhere—they sit at kitchen tables, they forge rivers, they look down from a mile in the air. What makes a photo worth capturing? What makes a photo a true portrait of South Dakota life?

I’ve driven over 300,000 miles, zig zagging across our state in the nearly eight years I’ve lived here. There are a lot of scenes that stand out when I think of South Dakota: a lone tree in the middle of a pasture, small draws filled with lush green grasses, rolling hills that carry the horizon all the way to Wyoming. But I think what stands out the most are the families and faces of people that I’ve gotten to meet.

A true portrait is a photograph that simply says, this is a slice of everyday life. And for a lot of folks in our rural communities, that life is challenging. There is a lot of physical work involved and people take a great deal of pride in that. South Dakotans are proud. They are hard working. And you’ve got to be pretty darn resilient to put up with our winters.

Are there any clichés in photographing rural life that you steer away from?

I think one of the biggest challenges photojournalists can face in capturing rural life is turning the lens into a vehicle to capture poverty porn. This is a challenge urban journalists face as well.

When I get calls from clients to photograph stories and issues where rural poverty can be a huge driving point in the issue at hand, it’s a delicate balance. I want to capture how rural isolation and lack of services can contribute to a community’s issues, but I’m not going to deliver photos that show everything as bleak and lifeless and lacking hope.

What’s the most challenging photo or series you’ve captured while living in South Dakota?

During my first year at the Rapid City Journal, I had the opportunity to team up with a talented reporter on a story about Ali Nowotny, a teenager who would be undergoing surgery to remove a mass in her brain. We were able to follow her from the beginning of her journey through her recovery, and then would continue to check in on her life in the years to follow.

It was such an incredible opportunity to get to spend that much time with one person, their family, their friends, and be able to gain the trust needed to access to what they were going through. But the story was challenging to tell and heavy to carry. It was a story that involved a lot of tears and lying in bed at night wondering about how Ali was feeling or how her dad was coping.

When you are out shooting, how much of it is instinctual? How much is planned?

Most of the time my trips are planned. Sadly, I have fewer and fewer days where I get to just wander with my camera. But while the outing may be planned, the photos themselves are more serendipitous.

There are some essentials that you mentally check off your list when you photograph most stories: faces; interactions; scene-setters; and wide, medium, and tight moments. But you’re also always watching and listening for the unexpected. And the listening part is so key—a story evolves and changes during the reporting process. And your plans for shooting need to be able to change and move with that evolution. I love being able to give in to the serendipity of it all. That’s often where the strongest photos come from.

What have you learned from photographing South Dakota? What do you want your photography to teach others?

It’s too easy for our rural parts of the country to be forgotten. I don’t see South Dakota as a “flyover state.”

South Dakota sits at the edge of the West, a place I feel uniquely links the Midwest with the West. It’s a place where the rolling prairie meets the big sky. There are towns and communities where time has stood still in a way, leaving scenes reminiscent of the ’40s and ’50s. While small towns might move a little slower than urban communities, it’s important for people to know and recognize the life happening here and understand the great sense of community in isolated places like these.