What is Harm Reduction Practice?

Harm reduction practice is an approach for substance abuse treatment that involves a set of techniques that are negotiated by the client and provider around the outcomes that he or she is most likely to achieve. The focus of this practice is to reduce the risky behaviors and negative consequences of substance abuse, and it neither condemns nor condones any behavior. By incorporating strategies on a gradual basis beginning with safer drug use, moving onto managed substance abuse and finally to abstinence, this specific practice helps patients affect positive changes in their lives.

Principles of Harm Reduction

The philosophy embraces a nonjudgmental stance, trust and respect as the essential components of a positive and effective therapeutic relationship. This approach assumes that clients have the desire to make a positive change in their lives and that the clinician is able to use motivational strategies to help their clients move as far along the change continuum as possible. There are several principles of the philosophy, including the lack of pre-defined outcomes and a focus on reducing harm, not consumption. Additionally, clients have a voice, they are treated with dignity and they are expected to take responsibility for their own behaviors. In its basic form, this approach recognizes and accepts a client’s decision to use.

Why is it Necessary?

This technique is just one treatment approach among many that may be required to provide the client with choices. The approach provides a holistic perspective for changing a client’s actions as it understands the realities of sex-based discrimination, past trauma, social isolation, racism, class, poverty and other social inequalities that affect people’s capacity and vulnerability to effectively deal with substance use. This approach acknowledges that the client is the catalyst for change who, through individual self-direction, works to improve his or her overall health by minimizing unhealthy practices.

Myth Versus Fact

Although some may believe that this approach is opposed to abstinence and therefore clashes with traditional substance abuse treatments, the reality is that it includes abstinence as one possible goal across a continuum of potential outcomes. Another myth is that the technique encourages drug use, but it is actually neither against nor for drug use. Rather, it does not seek to stop drug use entirely unless a client makes that his or her goal, and it focuses on supporting a client’s efforts to reduce the harms caused by risky behaviors or drug use. At its basic form, this approach neither condemns nor condones any behavior and certainly does not maintain an “anything goes” attitude. Instead, it evaluates the consequences of a client’s behavior and attempts to reduce the dangers and negative consequences that those behaviors pose for communities, families and individuals.

This approach is used to manage behaviors such as sexual activity and recreational drug use in a number of settings. Critics of the method believe that tolerating illegal or risky behavior sends a message to the community that these behaviors are acceptable, while others believe that the policies help to lessen the negative physical and/or social consequences associated with various human behaviors. For instance, needle-exchange programs reduce the likelihood that users of injectable drugs will share syringes, which can lead to infections such as hepatitis C or HIV. Through alternative methods of treatment such as harm reduction practices, clients may be more likely to abstain from harmful behaviors in the long run.

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