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Harm Reduction and Recovery-Oriented Care |
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by Les Lucas, LMFT Recovery to Practice Highlights April 19, 2012 |
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Practitioners who employ harm reduction strategies meet consumers “where they are at” to address substance use. They aim to help people achieve optimum mental health and positive treatment outcomes, while always keeping the consumer’s goals in mind. As with other recovery-oriented services (ROS), there is no universal definition or formula for implementing harm reduction. The fact is, all evidence-based practices are used appropriately if they encourage consumers to make choices that reduce harm and achieve their fundamental objectives. It’s the same in ROS. As we meet consumers where they are at, we find ourselves describing individualized, person-driven wellness and strength-based clinical services that reflect our work with people who have other psychiatric challenges, such as depression, schizophrenia, and obsessive compulsive disorder. Within this broader person-centered context, the harm reduction model and harm reduction counseling (HRC) include a set of practical strategies that can reduce the negative consequences of drug use. HRC incorporates techniques to help consumers at all stages-from dangerous behavior (harmful use), to safer behavior (managed/controlled use), to non-harmful use or abstinence. Harm reduction strategies may vary depending on an individual’s experience, i.e., whether the person suffers from substance abuse (actively making harmful choices, but still able to control his or her use) or substance dependence (a brain disorder that hinders one’s ability to control use, even when he or she wants to). However, it is possible to help people in both groups make better decisions to reduce harm-even without becoming fully abstinent. As with substance use disorders, interventions account for the level of acuity, severity, and disability. HRC incorporates the following principles, which are central to effective counseling and consistent with good recovery-oriented practices. HRC strives to minimize harm for people who use alcohol or drugs, rather than ignoring or condemning them. In ROS, we work to reduce harm while addressing other thinking, feeling, and behavior challenges. We accept-for better or worse-that consumers’ psychiatric symptoms are part of our world. HRC views substance use as a complex, multifaceted phenomenon that encompasses a continuum of behaviors (from use, to abuse, to severe dependence). There is also a continuum of outcomes, from controlled use, to non-harmful use, to total abstinence. In ROS, we recognize consumers have a continuum of severity as well as a range of successful methods for living with and managing those challenges. HRC establishes personal goals, such as improving the quality of individual and community life (not necessarily cessation of all drug use), as criteria for successful interventions and policies. In ROS, we work with consumers to identify personal recovery goals that help build practical interventions and policies. HRC calls for the welcoming, nonjudgmental, and non-coercive provision of services and resources for people who use substances. In ROS, we call this “welcoming and unconditional positive regard,” which focuses on the consumer as a person and not the label or symptoms. We refrain from judging consumers’ lifestyle choices and help them live well in the community. HRC gives people who use or have used substances a real voice and representation in programs and policies designed to serve them. In ROS, our policies and procedures require and encourage input from mental health consumers to create programs and policies for their benefit. HRC recognizes poverty, racism, social isolation, sexism, and other social inequalities affect people’s capacity for managing substance use-related harm. In ROS, we use case management, housing, food stamps, and payee services to assist consumers with food, shelter, and clothing needs. Staff and consumers recognize past trauma, stigma, and racial injustice affect one’s ability to handle aspects of thinking, feeling, and behavior challenges. Les Lucas is a Clinical Supervisor in the Fresno County Department of Behavioral Health, Substance Abuse Division. He can be reached at llucas@co.fresno.ca.us. |