Harm reduction

In the mental health field there are dozens of avenues, or modalities, that can be used to help client's with their needs. They can be broken down into two categories, evidence based practices and non-evidence based practices. Evidence based practices are the modalities and treatments that have been studied and practiced and a proven high success rate. Cognitive Behavioral Therapy, Internal Systems and Motivational Interviewing are just a few of a long list of evidence based practices. At Cornerstone we strive to use the latest and most effective evidence based practices with our clients.

An evidence-based practice that is gaining steam is the Harm Reduction method. This method takes into consideration that immediate change, for most, is an impossible task. For example, those who make a new year's resolution to get healthy. Their intentions are good and their will is strong. They toss out all the junk food, buy a gym membership, order giant tubs of protein, Google the best diets and work out routines, and stock their fridge with only healthy food. The first few days they stick to their goals by eating right and hitting the gym everyday. They begin telling everyone how good they feel and they are seeing changes in the scale. The pink cloud, when you're excited and confident about your changes, eventually begins to dissipate. The speed at which the pink cloud fades has many factors. Some will not make it past the first few days, while others last a couple weeks to a month, and a few make it two or more months. By mid February the gyms are empty, vegetables are rotting in the fridge behind the junk food, the pants purchased go back into the pile of clothes you that you'll fit into "some day" and we ignore the gaze of those who we gloated to about our progress.

The problem described in the scenario is not the individual's lack of willpower, but an attempt to change their entire lifestyle, something that took them years to develop, overnight. In our heads we see ourselves going through the 30-second movie montage and meeting our end goals quickly. From the start we are almost guaranteed to fail because we are changing too much at once. This is where the harm reduction approach comes in. Rather than jumping in all at once, a long term goal is set and short term manageable goals are set. Rather than changing our entire diet over night we take a small step and add a salad once a week and add 500 steps to your day. These steps are manageable and once they become habit the next step can be taken.

For example, those who go through anger management are encouraged to see if they can hold off blowing up for five-seconds. The long term goal is to teach the individual how to manage their anger and anxiety with the development of new neural pathways that utilize healthy coping skills rather than lashing out or bottling up. Just like most of our freeways, this construction takes a long time. We encourage the client to start with the five-seconds and see if they can begin identifying how they feel emotionally and physiologically prior to losing their cool. Once they can successfully make it to five-seconds, we add five more, or encourage them to leave the room when they begin to feel overloaded. Eventually their fuse will become long enough that their anger will not be nearly as detrimental or destructive.

Most are fine with a harm reduction approach, except when they find out that the term "harm reduction" was coined for substance abuse. For the loved one's of those struggling in addiction a harm reduction approach often appears as an excuse to keep using. This mindset is formed for several reasons; an all or nothing culture associated with drug abuse and sobriety, the continued broken promises made by the one in addiction to their family, a societal view that addiction and substance use disorders are choices rather than diseases, etc. Not to excuse their choices or behavior, but many who relapse in a standard program find greater success in harm reduction approaches. We begin by encouraging those who drink too much to leave a half a beer behind or a finger of alcohol in the bottle. Every week they are encouraged to leave a little more and more. This approach allows our counselors and therapists to work on the underlying issues behind their addiction, while also imparting new life skills that make leaving more alcohol behind easier for the client. Given enough time we hope that each client will reach total sobriety.

For some, a harm reduction approach may mean they never stop using completely. We would call it a success as long their use has minimal impact on their social, psychological and physically health. I have heard it compared to type-2 diabetes, which can be managed with diet and exercise. For most the level of dieting an exercise alone is not realistic, nor would it fit into their lifestyle, therefore they will continue to need medication, some for the rest of their life. As a society we do not frown upon those with type-2 diabetes, in fact we celebrate the harm reduction approach that is associated with their self care. Therefore, let us celebrate with those who are taking a harm reduction approach with their substance use disorder. At Cornerstone we strive for every client to reach total sobriety, but for some it is not a reality and we work with them to slowly lower the amount they use until they can fully function in life again.

If you have any questions about our approaches to substance abuse treatment and/or the harm reduction approach please do not hesitate to reach out to us. Our phone number is (661) 750-0438 and our email is [email protected].