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How to Practice Harm Reduction



Also known as harm minimization, harm reduction is an umbrella term that refers to the ongoing and past efforts to reduce the negative social, political, and economic effects of drug use and other negative behaviors. This is to say that harm reduction is an effort to minimize drug use through prevention, treatment, and (most importantly) enforcement. However, harm reduction does not only deal with substance use. It also deals with the “negative consequences associated” with substance abuse, and other negative behaviors [4]. Some ways that harm reduction can reduce these habits are through things such as needle exchange programs to reduce HIV transmission, “encouraging safe sex, replacing binge eating with healthier alternatives, providing clean razors for those engaging in cutting/self-harm behaviors, or supporting even 5 minutes of exercise per day,” [4]. It is a step in the right direction, which can lead individuals down a safer path for the future.


Alternatively to abstinence, harm reduction does not require the person going through substance abuse or other negative behavior to completely cut off their behavior, as it is often a coping mechanism for many. This practice strays away from more judgmental techniques, instead leaning toward “directive techniques, including motivational interviewing […] to allow the client to explore reasons for change,” [4]. Instead of demanding change, it encourages the participant to find their own reasons for quitting. Harm reduction is a worldwide effort, and research is constantly being done in order to see what method of reduction works best for those struggling with drug usage.


In the U.S., harm reduction efforts are being practiced among different age groups. Age is an important factor when it comes to drug usage, as early use can lead to later consumption. Many young students and parents have probably heard of “Project DARE (Drug Abuse Resistance Education),” whose goal was abstinence [4]. This project did not yield positive results; it actually posed “potentially harmful effects” to those who sought help from the organization [4]. Programs that were more consistent with principles used in harm reduction such as “social skills, resistance skills training, and normative education” had better progress, although little [4]. For college students, “probably the most studied group in terms of alcohol harm reduction programs,” different results were shown through the use of harm reduction approaches [4]. Two different approaches, including “Alcohol Skills Training Program (ASTP) and Brief Alcohol Screening and Intervention for College Students (BASICS),” were used, and it was shown that “negative consequences with reductions sustained at 2-year follow-up,” [4]. For adults, workplace programs were implemented for heavy drinkers that were employed full-time. It was shown that, on average, workplace programs led to the subjects remaining abstinent for 3 months.


Trauma centers are also a resource for adults seeking harm reduction. Most patients go into trauma centers, and “almost one-quarter of trauma patients screened positive for substance-related risky behaviors, abuse, or dependence,” [4]. Although this is a fairly large number of people, it is shown that “patients are not likely to recognize a substance use problem or be motivated to change their behavior and may not have sought treatment in the past,” [4]. By identifying negative behaviors, it is possible to achieve immense progress later on toward reduction.


Two studies were done in Australia to research and practice harm reduction. Higgs, Moore, and Aitken researched a small suburb in Melbourne, revealing that creating positive relationships with drug users is important. This means going “beyond ‘creating rapport’ to include advocacy (e.g. facilitating greater links to social health/welfare agencies),” [2]. They also found that it is important, when doing research on harm reduction, to “employ appropriately skilled researchers who are flexible, innovative, and comfortable in street settings,” [2]. In order to do the research, it is important to employ qualified people to go into the field and interact with those who are using drugs.


Cameron Duff, also from Australia, believes that harm reduction can be achieved by looking “beyond the everyday tools of harm reduction like needle and syringe programs and peer education to ‘enabling places’ and ‘enabling resource’ areas where public policymakers and social planners can ensure the delivery of more innovative harm reduction policies and programs,'' [1]. Duff explains how there are “three classes of enabling resources; social, material and affective resources,”[1]. Social capital is an important aspect of resource enablement. It is the “analysis of the myriad bonds of trust, reciprocity, and cooperation that characterize social life in both formal and informal settings,'' [1]. In this way, social capital helps to organize coordinated actions where there is “the degree of trust, familiarity, values and neighborhood network ties,” [1]. With drug use, cohesion is very important for facilitating the distribution of resources and healthy communities.


Duff goes on to explain the importance of material resources in the efforts to practice harm reduction. It is “likely the most familiar of enabling resources” and can include financial resources, health care, transport, etc. [1]. There are other material resources, as well, such as “sterile needles and syringes,” which promote safer injections [1]. Affective resources are defined as “felt and lived dimensions of everyday life,” [1]. These resources have to do with emotions that bind the social relationships that were discussed earlier, but they also include experiences of hope.


South Africa handles drug reduction through substance use programs. There are several “intersection health and social challenges, among which is the perception of the widespread presence and broad-ranging adverse effects of substance use, specifically heroin,” within Tshwane, a city in South Africa [6]. The city of Tshwane developed the “Community Oriented Substance Use Programme (COSUP)” in 2016 [6]. As requested by the “Department of Family Medicine (DFM, University of Pretoria),” this program is “the first publicly funded, community-based programmatic response to the use of unregulated drugs in SA,” [6]. It is important to monitor substance abuse within South Africa, because “cannabis, heroin, cocaine, and methcathinone were the most common primary substances of use among patients registered at substance use treatment centers,” [6]. Some ways that COSUP practices harm reduction include “physical, mental, and substance use screenings, assessments, brief interventions and referrals; harm reduction counseling; opioid substitution therapy (OST); and needle and syringe services as well as social services, skills development and shelter,” [6]. At first, only seven sites were functioning in 2017, but by 2019 there were ten more sites that became available to the public. Twelve of those sites included “ablution facilities, nutrition, computers, other psychosocial services and/or safe spaces to socialize,” [6].


So, have any of these methods of harm reduction helped to reduce the amount of substance use in these areas? In South Africa, critical issues related to substance use became more “sustainable and scalable,” [6]. Through these facilities, there became a more systematic way of distributing affordable resources and making a clear change in the war against drugs. In Australia, the same has been established by doing research in the field and enabling “social, material and affective resources,” [1]. In the U.S., there is the practice of nicotine replacement, opioid substitution, and safe injection sites. So, as we can see, there are a ton of resources that are provided through harm reduction, and it is accessible in many different places. If you or someone you know is struggling with negative behavior because of substance use, you can find the resources to help you quit.




References:

  1. Duff C. Enabling places and enabling resources: new directions for harm reduction research and practice. Drug Alcohol Rev. 2010 May;29(3):337-44. doi: 10.1111/j.1465-3362.2010.00187.x. PMID: 20565528.

  2. Higgs P, Moore D, Aitken C. Engagement, reciprocity and advocacy: ethical harm reduction practice in research with injecting drug users. Drug Alcohol Rev. 2006 Sep;25(5):419-23. doi: 10.1080/09595230600876606. PMID: 16939936.

  3. Järvinen M. Approaches to methadone treatment: harm reduction in theory and practice. Sociol Health Illn. 2008 Nov;30(7):975-91. doi: 10.1111/j.1467-9566.2008.01094.x. Epub 2008 Jun 18. PMID: 18564977.

  4. Logan DE, Marlatt GA. Harm reduction therapy: a practice-friendly review of research. J Clin Psychol. 2010 Feb;66(2):201-14. doi: 10.1002/jclp.20669. PMID: 20049923; PMCID: PMC3928290.

  5. Potter K, Virtanen H, Luca P, Pacaud D, Nettel-Aguirre A, Kaminsky L, Ho J. Knowledge and practice of harm-reduction behaviours for alcohol and other illicit substance use in adolescents with type 1 diabetes. Paediatr Child Health. 2019 Feb;24(1):e51-e56. doi: 10.1093/pch/pxy075. Epub 2018 Jun 7. PMID: 30833824; PMCID: PMC6376295.

  6. Scheibe A, Shelly S, Hugo J, Mohale M, Lalla S, Renkin W, Gloeck N, Khambule S, Kroukamp L, Bhoora U, Marcus TS. Harm reduction in practice - The Community Oriented Substance Use Programme in Tshwane. Afr J Prim Health Care Fam Med. 2020 May 6;12(1):e1-e6. doi: 10.4102/phcfm.v12i1.2285. PMID: 32501031; PMCID: PMC7284158.

 

Contributors:

Author: Kayjah Taylor

Editor: Lauryn Agron and Liam Lynch

Health scientist: Chantelle Moore


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