The following is an excerpt from the CNRA Clinical Corner.
There are different modalities and evidence-based interventions for substance use treatment. The treatment must be based on the needs and goals of the client. One modality for substance use treatment is Harm Reduction. Harm reduction integrates a range of strategies aimed at increasing safer use, controlled use and managing the triggers and consequences of use. Counselors in the CNRA discuss the modality of Harm Reduction.
Why do you think Harm Reduction is an important aspect of substance use treatment?
“One of the key principles of harm reduction in substance use treatment is “meet people where they are”. This is one of the first foundational therapeutic aspects of therapy that I ever learned, meeting people where they are, and I believe that it is vital to being non-judgmental as a therapist. People who use substances deserve safety, just like anyone else. A goal of harm reduction is to reduce the likelihood that a person who uses substances will die from their use. Ultimately, harm reduction allows a person to continue to do their best in substance use treatment and gives them a chance at the life they desire.” – Marissa Kepple, Counselor
“Harm reduction is vital because clients are often not ready or able to completely quit using drugs when they enter treatment for a variety of reasons such as lack of social-emotional support, lack of healthy coping skills, or the presence of untreated mental health disorders. Harm reduction allows clients to develop skills and behaviors to reduce their risk while continuing to use drugs, until the other pillars important in recovery are present.” – Nina Moak, Counselor
“I think it is a very important aspect of treatment because some are not ready to stop for a variety of reasons. One thing I think most people don’t consider is that without the drugs, the psychiatric concerns that have been masked by the drugs (i.e. severe depression, or PTSD) can be debilitating for someone who has not learned new ways to cope. Harm reduction is a great way for someone in this position to gradually learn how to cope with their mental health conditions while cutting down on substance use. In addition to improved coping, harm reduction also helps them reduce physiological harm caused by prolonged substance use.” – Charli Washington, Counselor
How do you talk to your client about safe ways to use?
“After assessing their pattern of use I typically offer my clients some education about how their method, frequency, or amount used at each occasion may increase (or reduce) the likelihood of harmful outcomes. I often do some investigation to see what they are willing to change about their pattern of use and start offering suggestions there.” – Charli Washington, Counselor
“Talking about safe ways to use varies from client to client. It starts by assessing the client’s current risk by having open, nonjudgmental discussions with the client about their use (method, frequency, location of getting high, etc.) then brainstorming small initial changes. For example, if a client reports getting high on cocaine then drives, we might discuss how that client might stay in one place until sober again. During these conversations it’s helpful to elicit ideas from clients on what they think might be feasible for them to try, or what strategies they’ve use previously that were helpful. If the conversation is collaborative the client is more likely to try some of the skills.” – Nina Moak, Counselor
“When I talk to my clients about safe practices, I like to use lots of metaphors. When we go outside, we use sunscreen. When we drive, we wear seatbelts. We practice harm reduction in lots of ways, and there are ways that they can practice harm reduction in using substances. We may then take some time to talk about some examples of safe use, or brainstorm ideas of how they may use safely in the future.” – Marissa Kepple, Counselor