Harm reduction is an evidence-based, if controversial, approach to substance use difficulties. Many individuals as well as some clinicians believe the approach promotes or reinforces substance use behaviors. But harm reduction for addiction is often misunderstood.
Now, we’re not saying here that anyone should or should not use harm reduction for addiction. Each professional should decide whether or not they want to use harm reduction. But information can’t hurt! To understand the approach and inform that decision.
Harm reduction focuses on finding ways to minimize risk of harm that accompanies problematic substance use. Free syringe exchange programs, fentanyl test strips, and naloxone distribution programs are examples of specific efforts. This is part of the controversial part.
But harm reduction for addiction also often involves meeting with the individual to assess use and assess safety. Unlike SBIRT or traditional substance abuse approaches, harm reduction does not explicitly emphasize abstinence. The approach emphasizes remaining unconditionally supportive, no matter client progress.
The clinician gains an understanding of the clients goals and values, then validates the heck out of any behavior that seems to fit those aims (however small). For example, a client may be attempting to regain child custody and value being a responsible parent. The clinician might use genuine statements like, “You cleaned your arm before shooting up, you ARE really responsible and caring.”
These statements often greatly surprise clients, especially since the system and society often tell them they are failing or are faulty individuals. This surprise effect is thought to leave the client with a great sense of self-efficacy, value, trust in treatment, and an improved sense of social support. For you Motivational Interviewing (MI) fans out there, you probably already see how MI approaches fit well into Harm Reduction.
Harm reduction for addiction on its own has a host of benefits. It appears to increase safety, reduce overdose deaths, reduce disease transmission, and increase education and awareness for users. It also appears to effectively increase client willingness to turn to evidence-based approaches for abstinence (e.g., 12-Step programs, SMART Recovery, CBT, etc.).
Harm reduction for addiction is controversial at face value. However, evidence shows extensive benefits for individuals and society. And surprisingly appears to bring people closer to, not further from, abstinence.
