harm reduction implementing harm reduction strategies in your health center

Harm Reduction

Implementing Harm Reduction Strategies in Your Health Center

Heartland Alliance for Human Needs & Human Rights

Ed Stellon, M.S., M.A., CADC

Director of Resource and Community Development, Mental Health & Addiction Services, Heartland Health Outreach

[email protected] www.heartlandalliance.org


Harm Reduction

People marginalized by high-risk behaviors have the right to access a continuum of service options and strategies that include outcomes such as reduced harm, abstinence, and enhanced quality of life. The philosophy of harm reduction recognizes the resilience of people who engage in these behaviors and aims to reduce stigma associated with them. Harm reduction does not promote or enable harmful behaviors, or protect individual participants from experiencing the consequences of the choices they make.


Harm Reduction and Substance Use

Harm reduction is a set of practical strategies that reduce negative consequences of drug use, incorporating a spectrum of strategies from safer use, to managed use to abstinence. Harm reduction strategies meet drug users “where they’re at,” addressing conditions of use along with the use itself. – Harm Reduction Coalition


Harm Reduction and other High-risk Behavior

Many of the same strategies can be applied to other high-risk behaviors

Harm reduction is consumer-centered, taking into account the needs articulated by the consumer and avoiding labeling


Harm Reduction as a Continuum

Safer Sex – condom use, avoidance of risky sexual practices, abstinence……

Safer Driving – speed limits, seat belts, intoxication limits, air bags, emission controls, alternatives to driving……

Safer Drug Use – reduced use, avoidance of risky routes of administration, drug substitution, safe using partners (designated driver), abstinence…..


Harm Reduction and Drug Use – Why the discomfort?

Cultural and social factors – America has an uneasy history of acceptance of drug use; politics, not science, is the basis for drug policy

Mythology – our perception of why some drugs are bad, some are not so bad, and others are o.k. is often based on biased information


Harm Reduction and Abstinence

Harm reduction and abstinence are highly congruent goals.

Harm reduction expands the therapeutic conversation, allowing providers to intervene with active users who are not yet contemplating abstinence.

Harm reduction strategies can be used at any phase in the change process.


Principles of Harm Reduction

User’s decision to use is accepted (pragmatism)

User is treated with dignity User expected to take responsibility for his/her

own behavior Users have a voice Reducing harm not consumption No pre-defined outcomes


What Harm Reduction Is Not…

Neither for or against drug use Tacit consent to use drugs “Don’t ask, don’t tell” “Trojan horse” for drug legalization “Anything goes” Anti-abstinence


We Practice Harm Reduction by:

Offering a range of options and choices to facilitate positive change

Exploring the benefits of changing, reducing or eliminating high-risk behaviors

Establishing and maintaining a relationship with participants who continue to engage in high-risk behaviors

Defining and re-defining success with participants


We Practice Harm Reduction by:

Helping participants build motivation Working with participants to develop adaptive

coping strategies Being non-judgmental and providing balanced,

factual information Recognizing decision-making power rests with

the participant


Best Practices

Balance the practice of harm reduction between the needs of individual, family, community and organization.

Offer objective, factual information, both positive and negative, in the context of educating regarding choices and decision-making.

Clarify consequences of choices, both positive and negative.


Best Practices

Build policies and practices around safety issues and participant functioning – focus on expectations and responsibilities rather than rules.

Acknowledge change is hard, ambivalence is normal, and look for opportunities to build motivation to change.

Celebrate collaboratively defined successes and identify lessons learned from setbacks.


Helpful Websites

Harm Reduction Coalition: www.harmreduction.org

International Harm Reduction Association: www.ihra.net

Harm Reduction Therapy Center: www.harmreductiontherapy.org

Harm Reduction Journal: www.harmreductionjournal.com

harm reduction implementing harm reduction strategies in your health center

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