Harm Reduction is an often misunderstood methodology and philosophy for working with substance users who might not otherwise receive services. For example, a motto of the approach is to meet people where they are and help them make any positive change. This might mean meeting with a client that is high on crystal meth and in a delusional state of mind, or still having a session with an intoxicated client who just came from the bar after four beers.
Most therapists would cringe at such an approach. How can one possibly help any client who is in such an altered state of mind? Academic programs even advise therapists against meeting with people under the influence. The reasoning might be that doing so is condoning drug use.
I propose that harm reduction, meeting clients whether they are high, low or experiencing psychosis, is a more humane approach to working with people. Let me explain.
An often referred to concept within this community is that connection is the opposite of addiction. By not meeting with a client, the therapist is breaking a significant bond and potentially sending the person into even more of a tailspin. Think about it. How can we turn someone away when they actually need us the most? How healing it can be for people to be accepted however they are. Now that is true unconditional, positive regard.
I can even speak from personal experience as a substance use counselor how profound it was for a client to be encouraged to meet with me even when high, instead of how they are treated other places, shamed for even using, much less showing up still in an altered state. I could see on his face what a relief it was that they could be however they are and still be supported and cared for. The approach of tough love, of cutting addicts off from social support, is the exact opposite of what is actually needed to help people heal. Outdated models of substance use treatment prevail, much to the detriment of our whole society. It’s time to move forward.
This brings me to the other concept mentioned so far, of helping people make any positive change. Whereas other programs say one must be abstinent before they can even begin treatment, harm reduction allows clients to continue to use while receiving services. How baffling if one stops to think that we insist the struggle they are against must be solved on their own before they can even get help. In contrast, one approach within harm reduction philosophy, called substance use management, even takes for granted that clients will use and focuses instead on helping them do so more safely, to reduce the risks of doing drugs.
Inherent in this worldview is that people have a right to put into their body whatever they want. Consenting adults are judged to be capable of making their own decisions in life, and are not treated like children that fucked up and need to be told by an authority how to behave. Even further, the client is seen as the expert on their own life, instead of the top-down authoritarian approach of some other modalities, where the counselor or program is there to tell the client how to recover.
Harm reduction is a sensible approach to a world that is not black and white. There are shades of gray inherent in life that must be taken into consideration. Society approves the use of some substances much more than others. For example, drinking socially is perfectly fine, but doing so solo or early in the morning is stigmatized. How arbitrary. If a person is able to manage their life fine while using a substance however they deem fit, why should that be a concern of anyone else.
Really driving home this point, our culture demonizes people who use crystal meth as tweakers that are beneath the level of acceptable. Little do the majority realize how many successful people, working men and women, can use and still function as well as the rest of us, employed and contributing to their community.
The stereotype of the busted up user is not necessarily true. Some people use this powerful stimulant to be productive during the day, as a maintenance user and not as a way of getting high. In a lot of ways, meth is really no different that adderall. Each is a means of altering our body chemistry to boost the activity of the central nervous system. Would we tell someone with ADD they are inferior for needing a stimulant like ritalin to help them focus? Absolutely not.
Overall, people who don’t understand serious substance use might do well to look at their own lives and the people around them, and see how smoking cigarettes, drinking coffee and eating sugar are not so different than somebody using painkillers, hallucinogens or marijuana. Societies throughout human history have included substance use as an important part of their rituals. Perhaps these very same drugs deserve a place in our lives today, and a little bit of harm reduction is in order to give us the guidance to use them more safely. Now have that Cup of Joe, and start your day thinking how it’s not that different from a little puff of Crystal.