Harm Reduction: What is it?

The best comparison I heard recently to harm reduction, is the designated driver for alcohol. It’s well accepted & well advertised as a means to save lives, reduce fines and jail time, and still allows people to choose to drink as a stress reliever. Yet when people hear about needle exchange programs for heroin or meth users-or the granddaddy of HR- Injection sites; they lose their minds.

Harm Reduction becomes easier to accept when you have tried everything to get your loved one to stop. You realize that it’s now about keeping the substance user alive and safe until they can stop. Deedee Stout has a great video that explains it.

We become so accustomed to being shocked at our loved ones continued and usually progressive use, that we end up shutting down communication. Some parents even go so far as to say: “Call me when your clean”. What if someone you care about said to you, ” Call me when you are responsible and doing everything in the manner and time that I think you should”.

Instead, what if we find out what it is that keeps driving substance use? What if we could actually help them work on the original problem, not the symptom of the problem- which, in a lot of cases, substance use is.

This twitter thread has some great responses and ideas on harm reduction approaches, such as motivational interviewing questions.

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https://mobile.twitter.com/MyHarmReduction/status/1403775714600554505

One of my biggest day-to-day struggles with my son’s SUD is the reality of his risk of death. Fear drives us to into a place of powerlessness. We then project that fear onto a person with SUD who already has figured out how to numb his emotions and not ‘give a damn’ to those thoughts and feelings in themselves; so to have to somehow “fix” YOURS too – is overwhelming to them. They NEED us to be healthy, even-keeled, and strong. In this article it gives suggestions on how to parent using a harm reduction approach instead of with fear:

These are quotes from a past Harm Reduction event in NoBox Philippines last August, 2015 with Dr Andrew Tartarsky, who wrote ‘The Book’ on it: Harm Reduction Psychotherapy: A New Treatment for Drug and Alcohol Problems.

On Beginnings

Dr. T: “How can I be of help to you? “
Client: “Nobody ever asked me that question before, they just started telling me what I needed to do.”

On You:

“You are where you are for very complex and personal reasons, and we need to respect that.”

On Reality:

“Some of you might think a drug-free society is a good thing. Some might disagree. But the question is: is it realistic? What’s realistic? What’s realistic today?”

On Compassion and Acceptance:

“Maybe I don’t want you to be injecting drugs, maybe I don’t want you to be putting your life at risk. But that doesn’t mean that I can’t accept that that’s what you’re doing, with compassion, and then see how I can possibly be helpful to you.”

On Obvious Things that are Not So Obvious:

“What do you love about the drug? How do you benefit from the use? If we can’t talk about the positive benefits of drug use, how can we talk about alternative ways to get those benefits?”

On Assumptions:

“If people are using drugs in a way that is not problematic, they’re not likely to come to us for help, and it’s likely that they don’t need help. We shouldn’t presume that all drug use is problematic.”

On Risk:

“Risk is a part of life. Human relationships are risky. Intimacy is risky. Getting close to somebody is risky. We cannot live a risk-free life. So we identify the risk, learn about it, and learn how we can reduce that risk.”

On Things That Aren’t Making Sense:

“They call addiction a disease, but they treat the person like a bad person. It’s not a true disease model. Like a diabetes doctor kicking his patient out for eating a donut. Do we arrest people who have diabetes when they eat Twinkies?”

On Roads and Journeys:

“There are many roads to addiction, so it should make sense that there are many roads to recovery.”

“How long it takes is how long it takes.”

“We don’t need to know the destination to begin the journey.”

Taking on a Challenge … :

“How can we make treatment more appealing, engaging, and effective for this large group of people? If the treatment isn’t more appealing than the problem, why would somebody go to treatment?”

“They’re looking for help that will feel helpful.”

… And Not Underestimating People:

“Addictive people are not just having fun; they are frequently managing a great amount of distress. […] We learned that if we give them resources that appeals to them, that fits their needs, they will access them. What did that teach us? Drug users care about themselves, they care about their community, and they have the capacity and skills to access care.”

When One Size Fits All No Longer Fits:

“Many treatment programs are manualized, one size fits all, go through the phases. No doubt that some people benefit from that, they want it, they need it. [Harm Reduction] doesn’t have a cookbook. The form, the focus, the structure, the timing of the therapy completely emerges from the collaborative process. It’s much harder, and much more scary. We’re making it up with our clients as we go along. This is part of what makes it so radical, but also much more effective.”

On Whenever You Feel an Urge:

“Unwrap the urge: is there a part of me that lives in the urge? An angry part? Scared part? Sexual part? Playful part? Is there something that the urge wants to say? And if I know what this urge wants, is there an alternative choice that I can make that is actually less harmful and more effective?”

On Being Kind to Yourself (Because Science):

“Studies have shown that when we cultivate self-compassion, kindness towards ourselves, it is associated with reduction in anxiety, depression, and substance use. “

On Ambivalence, and Why It’s a Good Thing:

“If you only invite one part of you in the room, the part that wants to change, and we don’t invite the part that doesn’t want to change, what happens with that part? If we make an agreement only with the part that wants to change, the part that doesn’t want to change takes over as soon as the person leaves the office.”

“If you can split the ambivalence, get rid of the part of you that doesn’t want to use, now you’re off to the races. ‘Beam me up, Scotty.’ Splitting can grease the addictive flight. Helping patients stay ambivalent, sit with both sides, be connected to both parts of themselves, that’s the goal, really. So that when the part of them that wants to use, wants to engage in potentially destructive behavior, they can stay connected to the other part of them that doesn’t want to die, hurt themselves, lose the money, risk the relationship.”

On Small Positive Changes:

“Having to commit to abstinence only is like going from no exercise at all to signing up to running a marathon.”

“Tiny little changes can help people begin to feel more empowered, more in charge, more in control, builds a sense of self-efficacy, a sense of hopefulness — these tiny changes can begin the process that leads to quantum change.

“These small steps build, they build optimism, they build on one another.” 

“Each time someone makes a positive steps, they’re feeling a little better, they’re feeling more hopeful.”

On What — Who — Matters:

“Somebody once pointed out: a dead drug user can’t recover. We can start by keeping people alive and safe: You’re worthy of staying alive. I care about you.”

Recovery Research Institute has more great advice.

Harm reduction doesn’t have to be scary. It doesn’t mean you’re condoning their drug use. It’s not encouraging more usage. Think of when you first found out your child was sexually active. It seemed too soon, you wanted them to wait, you wanted to at least be told before it happened! You might have lectured them or even shamed them, or secretly cried when you were alone. You might have consulted your clergy or your higher power, but soon you came to the realization that you probably didn’t have control over their actions; & the next best thing is to prevent harm. Teaching responsible disease and pregnancy prevention or directing them to someone who could.

The important thing is to keep the communication open so ultimately we keep the connection to our child, even though they may be an “adult”.