Harm Reduction 101Jenna Tine, LCSW

Senior Vice President of Outpatient Services at The Bridge, Inc.Naomi Weinstein, MPH

Vice President of Innovations at ICL (a MCTAC/CTAC partner)September 27th, 2018

Agenda‣ Welcome!‣ Poll questions – what do you think?‣ What is harm reduction‣ Why harm reduction‣ Required mindset‣ Harm reduction strategies

Poll question

Ideally, I would like all my clients who are drug users to strive for abstinence.

• Agree• Disagree

Poll question

Promoting safer use of drugs encourages drug use.

• Agree• Disagree

Common scenarios‣ He was sober for a while, but he seems to have

started using again.

‣ She denies she has a problem with alcohol.

‣ He gets very aggressive whenever he has been smoking K2.

‣ I spoke with him about his marijuana use, but he doesn’t want to stop.

‣ She keeps showing up intoxicated to group.

Traditional responses‣ Convince her it’s a problem and she needs to

stop now.‣ Strongly encourage him to go to treatment,

although he says he doesn’t want to stop.‣ Applaud her when she says she is willing to go

into a treatment program.

‣ And if these don’t work, either keep trying to get them “clean”, or just let them do what they do.

What is Harm Reduction?Harm reduction is a set of strategies designed to reduce the negative consequences associated with risky behaviors, including substance abuse.

Harm reduction is based on a firm belief in and respect for people who engage in risky behavior.

Harm reduction embraces all possible responses to risk behavior, from total abstinence to safer continued use.

It’s not just for drugsSubstance abuse is not the only risky behavior that can be addressed through harm reduction approaches

• Unprotected or otherwise risky sex• Tobacco use• Gambling• Screen time

Why Harm Reduction?

NormalSocialFun

Substance use…

NormalSocialFun

Morally badWeakWrong priorities

And when it crosses the line

NormalSocialFun

Morally badWeakWrong priorities

Stigma

And when it crosses the line

What kinds of stigma do people experience?

Let’s Chat…

Let’s Chat…

How do people behave or feel in response to this stigma?

• Angry/feel disrespected• Don’t want to trust/engage• Continue risky behavior

Let’s Chat…

How do people behave or feel in response to this stigma?

Harm reduction approaches point toward an alternate set

of outcomes.

Harm Reduction Mindset‣ People know themselves best.‣ Safety is more important than abstinence.‣ Drugs serve a purpose for most people, and may

make some people’s lives better or easier.‣ Some ways of using drugs are safer than other ways.‣ People are more likely to connect when they feel

liked and respected.‣ It is essential to be open to a full range of outcomes,

including abstinence.

Professionals need to be very aware of their own biases and judgments, and how these may be communicated to people receiving services.

Focusing on Risk and Safety

Abstinence/no use

Experimental

Occasional/casual

Regular

Heavy

Continuum of use frequency

Continuum of use

No risk

Minimal risk

Some risk

Heavy risk

Very risky use

Continuum of risky behavior

Focus on risk instead

Types of risks ‣ Health‣ Family/relationships‣ Legal‣ Economic‣ Housing‣ Spiritual/sense of self

At the core of Harm Reduction approaches are Safety Strategies

Harm Reduction ApproachTraditional Approach Harm Reduction Approach

Convince her the drinking is a problem and she needs to stop now.

Explore the ways alcohol helps her, any risks she faces, skills that might be helpful, and what she can do to reduce risk.

Strongly encourage him to go to treatment, although he says he doesn’t want to stop.

Talk with him about risks that concern him, such as possible arrest or overdose, and what he can do to stay safe.

Applaud her when she says she is willing to go into a treatment program.

Be a champion of abstinence based programs, if that is what she wants. If she changes her mind, support her in that decision and talk about other ways to reduce harm.

And if these don’t work, keep trying to get him clean, or just let him do what he does.

Focus on connection and trust, respect, and what can be done to promote safety and well-being.

Harm reduction opportunities

‣ Engagement

Safety strategies

Harm reduction opportunities

‣ Engagement‣ Assessment

Safety strategies

Harm Reduction Strategies

‣ Engagement‣ Assessment‣ Treatment planning

(person-centered)Safety strategies

Harm Reduction Strategies

‣ Engagement‣ Assessment‣ Treatment planning

(person-centered)‣ Service delivery

(person-centered)

Safety strategies

Harm Reduction Strategies

Safety strategies

‣ Engagement‣ Assessment‣ Treatment planning

(person-centered)‣ Service delivery (person-

centered) ‣ Motivational interviewing

Harm reduction programs are examples of harm reduction

principles in action

How can you apply harm reduction strategies in your work?

Questions?

Upcoming CTAC Events‣ Harm Reduction 102 -

• October 11, 2018 from 12p-1p• More in-depth discussion about using harm

reduction approaches with people, especially those not interested in reducing their use

‣ The Neurobiology of Resilience - A short video by Dr. James Rodriguez – to be released in October, 2018

Contact UsPlease contact us with any questions and/or concerns!

ctac.info@nyu.edu