What is Harm Reduction?
Harm Reduction is:
- Incorporating a spectrum of strategies including safer techniques, managed use, and abstinence to promote the dignity and wellbeing of people who use drugs
- A framework for understanding structural inequalities like poverty, racism, homophobia, classism, etc.
- Meeting people “where they are,” but not leaving them there
We Use People First Language:
- A person is a person first, and a behavior is something that can change — terms like “drug addict” or “user” imply someone is “something” instead of someone
- Stigma is a barrier to care and we want people to feel comfortable when accessing services
- People are more than their drug use and harm reduction focuses on the whole person
The Stages of Change
Health & Dignity: Establishes quality of individual and community life and wellbeing as the criteria for successful interventions and policies.
Participant Centered Services: Calls for nonjudgmental, non-coercive provision of services and resources to people who use drugs and the communities in which they live in order to assist them in reducing attendant harm.
Participant Involvement: Ensures participants and communities impacted have a real voice in the creation of programs and policies designed to serve them.
Participant Autonomy: Affirms participants as the primary agents of change, and seeks to empower participants to share information and support each other in strategies which meet their actual conditions of harm.
Sociocultural Factors: Recognizes that the realities of various social inequalities affect both people’s vulnerability to and capacity for effectively dealing with potential harm.
Pragmatism & Realism: Does not attempt to minimize or ignore the real and tragic harm and danger associated with drug use or other risk behaviors.
Why Harm Reduction Works:
- Provides a space for people to be open about their drug use and sexual behavior so it’s not hidden, perpetuating feelings of isolation
- Values people and their expertise so they feel empowered to determine and voice their own hierarchy of need and next steps are clear between provider and participant
- It is rooted in evidence-based practices that have shown decreases in health and social harms
- Keeps individuals engaged in care if they re-engage risk at any stage
Harm Reduction Interventions
- Risk Reduction: Tools and services to reduce potential harm
- (h)arm (r)eduction: The approach and fundamentals to reduce potential harm
- (H)arm (R)eduction: A philosophical and political movement focused on shifting power and resources to people most vulnerable to structural violence
Understanding Risk, Set and Setting
Nothing and no one exists in a vacuum. Understanding risk, set, and setting can give clinicians, harm reductionists, outreach workers, and other service providers more tools to support risk and harm reduction for participants.
Risk
The risk itself (e.g. related to drug use or sex work) that you’re discussing.
- What issue is being presented?
- What other possible sources of harm might be connected to the main issue?
- What drug is being used? What is the risk of overdose?
Set
The “mindset” that someone brings to the situation, including thoughts, mood and expectations.
- How are they feeling? Confident? Angry? Anxious?
- Are they physically in pain or hurt? Do they need to get well?
- Can they engage with you fully? Are their basic needs being met?
Setting
The physical and social environment of where the person is, and their perception of how that can promote/reduce risk.
- What is the physical environment where the potential harm is occuring? In a home? At work? On the street?
- Who is around them? Police, bystanders, other participants? How does the person present to these people? How will they react?
Case Study: Jessica
Jessica has been using heroin on and off for the past 10 years. Jessica stopped using for a few months while she was with her ex, but they recently broke up. She is feeling depressed and anxious and is looking to use again. She buys a bag and heads to the syringe exchange for some new points and heads to her encampment in a rush.
Using the questions above, how would Motivational Interviewing inform the way you would approach Jessica?