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AODA - What is Harm Reduction?

The Harm Reduction treatment model has been effective with adults who chronically use substances. Many of these clients were homeless and most were struggling with mental health concerns. All of these clients were active in their addiction and some were using substances daily. These were clients for whom a traditional 12-step or abstinence-only program would not have been effective. Instead, these clients found camaraderie, education and a chance to deal with their addiction in the Harm Reduction program. Minnesota leads the country regarding innovative treatment in chemical use. Community Care Programs, Inc. uses an assessment based on the Minnesota Matrix Model, which assesses six dimensions of functioning. It is the Rule 25 assessment, which is used by all counties in Minnesota to determine treatment recommendations.

Harm Reduction is a treatment which was initially developed in the 1980’s to address the growing risk of developing HIV from sharing infected needles. It is also a response to traditional programs wherein clients were routinely shamed about their chemical use or mental health symptoms. Harm Reduction is a treatment modality that serves to help clients no matter where they are in their chemical use, in a non-judgmental way while engaging the person in services. The goal for many clients remains abstinence, but this modality understands that abstinence may not be possible at every moment in time for all clients.

The primary tenants of Harm Reduction include the following:

  • Accepts for better and/or worse that licit and illicit drug use is part of our world and it is better to work to minimize its harmful effects rather than simply ignore or condemn them.
  • Understands drug use as a complex, multi-faceted phenomenon that encompasses a continuum of behaviors from severe abuse to total abstinence and some ways of using drugs are clearly safer than others.
  • Establishes quality of individual and community life and well-being - not necessarily cessation of all drug use - as the criteria for successful interventions and policies.
  • Calls for the non-judgmental, 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 harm.
  • Affirms drug users themselves as the primary agents of reducing the harms of their drug use and seeks to empower users to share information and support each other in strategies which meet their actual conditions of use.
  • Does not attempt to minimize or ignore the real and tragic harm and danger associated with licit and illicit drug use.

One of the primary differences in Harm Reduction is that, even if clients should use substances, they are not asked to leave treatment, as in many twelve-step programs. Just as a dietician would never penalize a client with diabetes who consumed a doughnut by kicking them out of an education program, the program does not punish those who have a lapse or slip or choose to continue prolonged use. Instead these are used as opportunities to learn about triggers, develop a stronger relapse prevention plan, or discuss the pros and cons of the use to determine if the use remains a benefit in their life.

The reasons that the substance is being used are also simultaneously explored and addressed. If the client is using the substance as a coping skill, as most chronic users are, this must be dealt with and other coping skills must be developed in its place. Just as in Trauma-Informed Care, it is about understanding and working through the behavior in order to understand the why.

In fact, Harm Reduction works seamlessly with CCR’s TIC program, and such other programs as Motivational Interviewing are woven throughout the Harm Reduction model. The Stages of Change are used in the assessment process in order to determine where the client is in the recovery process and, based on the information gathered, a treatment plan is developed. If, for example, the client is in the Pre-contemplation Stage of Change, meaning there is no thought of changing at this time, the client would be provided with as much education as possible in the hopes of moving to another Stage of Change.

Harm Reduction can also include such programs as Methadone Clinics, Suboxone programs, Wet Houses and needle exchange programs, among others, and because of this, Harm Reduction programs are often still seen as controversial. This is tied to the view that this is enabling the chemical use. Contrary to this popular misconception, Harm Reduction is not about supporting the chemical use, but supporting the client despite the chemical use, or more importantly, through the chemical use.

The current research about traditional AODA groups with teens indicates that this type of treatment modality with teens is ineffective, particularly the group component of traditional treatment. For example, the group approach would allow for seventeen-year-old clients to potentially teach fourteen-year-old clients about the newest exciting trends in drug and alcohol use. Furthermore, with this population there tends to be those that try to "one-up" each other regarding their use. Meanwhile, there is a growing body of evidence to support the Harm Reduction model and more and more treatment facilities are moving toward implementing this treatment in order to support clients where they are in their recovery, not where we, as clinicians, want them to be. Regardless, family therapy should also be included as much as possible as it is an integral piece of any effective treatment with children and adolescents.

While there are very few reference articles regarding use of the Harm Reduction model with teenagers, as this model remains somewhat controversial, for more information, this article from the National Center for Biotechnology Information does well in summing up the Harm Reduction approach.