odanu

Originally published at Am I the Only One Dancing?. Please leave any comments there.

Harm reduction isn’t a new concept, but it is one that is often unfamiliar to people who are not professional substance abuse or mental health counselors. Often, volunteers and front line staff who begin a job working in a program for people with addictions have never heard of it before. For them, two main questions almost immediately arise: 1) What is harm reduction and 2) What does it mean for me in my job? This article will attempt to answer both questions

The first principle of harm reduction, the one that governs all of the rest, is that substance abuse is primarily a public health problem and personal health problem, not primarily a moral issue or a criminal issue.

Keeping that principle in mind, it’s much easier to understand and accept the idea that the goal of harm reduction isn’t necessarily complete abstinence but reduction of substance (including alcohol) use and reduction of harmful side effects of use (such as infections from shared needles, DUIs, domestic violence, arrests, etc.)

At this point, a lot of people start protesting. ‘But substance abuse is harmful to society,’ they say. ‘We need to put an end to it.’ That would be nice, yes. But it’s not realistic. Substance abuse has been a part of human society ever since the first fermented fruit accidentally got someone drunk, or someone at a mushroom or chewed a leaf that made him or her feel funny.

Think of it like other diseases that have a lifestyle component. While a doctor might encourage someone with heart disease or diabetes to exercise more, eat better foods, or lose weight, that does not mean he doesn’t treat the symptoms of the disease. With harm reduction substance abuse policies, we adopt a similar idea.

There a lot of implications of using a harm reduction way of thinking for the way you will interact with people you are helping, and a lot more theory and background than a short blog post allows for. There are links for further research at the end of the article. In the meantime, here are some tips for working within a harm reduction state of mind:

When someone comes to you and admits a substance abuse problem, refrain from offering advice immediately. Instead, ask ‘what do you want to do about it?’ Many of the best solutions start with the person who has the problem, because he knows what will work best for him.
Acknowledge, praise and/or reward even small changes in behavior. Someone who used to drink a pint of whiskey every night and now is only drinking half a pint has improved. Make sure you notice and ‘catch’ her getting better.
Encourage the person you’re helping to set his own harm reduction goals. While it might be a less ambitious goal than the one you would set, the fact that it’s his own goal and not yours makes it more likely that it will be a successful goal.
Be realistic about relapse. Most people who are trying to change a behavior relapse periodically. When someone you help relapses, help her understand that relapse does not mean failure and does not mean she can’t succeed. Help her find a way to ‘get back on the wagon’.
Keep a list of harm reduction resources in your area for the people you’re helping. Free condoms, needle-replacing programs, and recovery groups that emphasize harm reduction are excellent resources for the person you’re helping.
Help the person you’re helping brainstorm ways to change behaviors in small ways that will improve their lives. For instance, encourage him to always take a friend to the bar and hand that friend the keys to his car, or smoke marijuana only in the evenings after work, or smoke crack instead of shoot it.
For your own well being, it’s important to take both a very short term point of view, noticing every improvement and pointing it out to the person you’re helping, and a very long term point of view, looking at the overall curve of behavior rather than at today’s relapse or setback. You will soon learn to be able to take setbacks in stride and continue being supportive.
If issues come up again and again as a ‘trigger’ to relapse, suggest to the person you’re helping that she might want to explore problem issues with a therapist or other supportive helper. Often, past trauma and mental illness play a role in substance abuse.
Never minimize or ignore substance abuse behavior. Acknowledge it, but move past it. ‘I think that your marijuana use is preventing you from getting the job you want’ or ‘Your drinking worries me. At your age, it’s very likely that you are developing serious liver damage’ are both complete legitimate things to say to the person you’re helping.
Emphasize the quality of life of the person you’re helping. Ask questions like ‘how is your substance abuse getting in the way of what you like?’ and ‘what would be better in your life if you reduced use or quit using (your drug of choice)’

Two articles I found useful for basic theory and background of harm reduction philosophy are:

Principles of Harm Reduction

What is Harm Reduction and How Do I Practice It?

Throughout the article I have linked to several books on Amazon.com that explore harm reduction more thoroughly. If you feel that you need further grounding in the ideas of harm reduction, I strongly suggest that you buy or borrow a copy of these books and do further research.

Subscribe and never miss an update!