Today’s most pressing issue
Weekly headlines warn of synthetic opioids and the resurgence of stimulant usage. Overdose deaths reach record numbers, year over year. All signs point to substance use disorders (SUD) as one of America’s most pressing issues—and its urgency grows.
Substance use isn’t just a newsworthy hot topic: It’s quiet and ever present in our day-to-day lives. Ranging from fentanyl and methamphetamine to “acceptable” substances such as tobacco and caffeine, mild and severe diagnoses, substance use is incredibly common. The sooner we acknowledge that fact, the sooner we can chip away at the shame of discussing it so we can open conversations that actually address SUDs.
Like every individual’s mental health, substance use is varied, nuanced, and affected by many factors. Our treatment approaches should be just as diverse.
What is harm reduction?
Depictions of harm reduction can cause confusion about its goals. It’s a term most commonly associated with substance use though can be used for other behaviors. Harm reduction is rooted in values of justice and aims to guide people towards positive change and behaviors, no matter how small the steps.
At its core, harm reduction is literally just that: reducing the harm caused by substance use through evidence-based strategies. Harm reduction prioritizes keeping people alive and protecting their health—physically and mentally.
Through a collaborative approach, harm reduction works within the realities of our world and addresses those truths, rather than deny them. A tangible example outside of substance use would be how people approach sex education. Abstinence-only approaches may theoretically prevent negative consequences but it doesn’t address the reality of human behavior. People end up with no information about sex and lots of feelings of guilt and shame if they practice sexual activity, leaving them with no resources nor support. Teaching about safe sex means people can make positive choices for themselves and their health.
The history of harm reduction
Substance use has been forever part of our global zeitgeist. Maybe you’ve seen or are already familiar with the concept of harm reduction. Perhaps images of the Syringe Exchange Program, or Hepatitis C treatments come to mind as you recall some of the AIDS and SUD harm reduction efforts from the 80s.
Harm reduction, while not new, has modern roots in research from observing the behavioral patterns of heroin use in Vietnam War veterans: Why did some veterans continue to use heroin while many did not? This question looms in the heads of both academics and those who work with people who use substances. They’ve repeatedly observed and found that there are many patterns of substance use, influenced by several different factors and uniquely dependent on each person's biology and environment in terms of era, culture, social groups, and more.
Today, harm reduction looks like many different things. It has to, with all of the different factors and patterns. Yes, there are supervised injection sites—which are proven to be effective and safe for getting people into treatment, preventing overdoses, and treating infectious diseases. Harm reduction also includes methods such as motivational interviewing, CRAFT interventions, and invitation to change, which are all considered harm reduction treatment modalities.
Incorporating harm reduction into your practice
If you’ve ever found yourself in a session with a client and asked them, “How do you feel about your use of alcohol?” or “Do you wish you had a different relationship to weed?” then you have done harm reduction work. Just as there is a wide range of substance use patterns, there is a wide range of harm reduction approaches.
Here are some ways to start incorporating harm reduction into your practice as an outpatient counselor.
Don’t be afraid to ask questions about substance use.
Questions can help you learn about your client and their relationship to substances. These are some examples:
- “What did you learn from your parents about alcohol use?”
- “What are your own boundaries with cocaine use?”
- “Do you feel safe when you use heroin?”
Help your clients name their own goals in the context of substance use.
In Harm Reduction Therapy, It's not your job to tell clients how much or how little they should use substances. Instead, identify the goals of a client and help them identify if their substance use is currently helping them meet those goals or moving them away from those goals.
Monitor and refer out if necessary.
Depending on your comfort level and the client's ability to function, it's important to monitor changes and to refer out when appropriate. Referring to a substance use specialist for an evaluation can often be a good first step if you are unsure what level of care is most appropriate for them.
Filter Mag is an informative harm reduction journalism site with lots of information on trends in the harm reduction space.
National Harm Reduction Coalition is a leading US-based nonprofit working to normalize harm reduction in America. Their site contains quality information and one-pagers, and they host professional trainings and an annual conference.
Harm Reduction International addresses that substance use is a global concern. Due to differing regulations in different countries, there are many novel approaches to address substance use disorders. HRI is a great resource to explore how other countries and providers are implementing harm reduction.
Read More and References
- Des Jarlais, D.C. Harm reduction in the USA: the research perspective and an archive to David Purchase. Harm Reduct J 14, 51 (2017). https://doi.org/10.1186/s12954-017-0178-6